1. The Advanced Practice Nurse Managed Clinic: Nurses Responding to Change Rosemary Goodyear Ed.D, APRN-BC, FAANP

2. APN Managed Clinics: Nurses Responding to Change Identify the professional requirements for operating an APN managed clinic Identify the professional requirements for operating an APN managed clinic List the social, cultural and legal implications of establishing an APNMC List the social, cultural and legal implications of establishing an APNMC Discuss the potential of this method of providing health care within the nations current health care system Discuss the potential of this method of providing health care within the nations current health care system

3. APN Managed Clinics Foundational elements of a APN Managed clinic : Foundational elements of a APN Managed clinic : Mission/Purpose/Philosophy Mission/Purpose/Philosophy Leadership and Management Leadership and Management Fiscal support Fiscal support Professional standards and/or regulations Professional standards and/or regulations Professionals prepared as APNs Professionals prepared as APNs Consumer/patient marketing Consumer/patient marketing

4. APN Managed Clinics Mission- Mission- Purpose- Purpose- Philosophy- Philosophy-

5. APN Managed Clinics Leadership Leadership Management Management

6. APN Managed Clinics Fiscal Support Fiscal Support

7. APN Managed Clinics Professional Standards Professional Standards Regulations Regulations

8. APN Managed Clinics APN Preparation APN Preparation

9. APN Managed Clinics Consumer/Patient Marketing Consumer/Patient Marketing

10. APN Managed Clinics History of nurses managing health care independently and interdependently: History of nurses managing health care independently and interdependently: In home during child birth and plagues In home during child birth and plagues In wars caring for the soldiers In wars caring for the soldiers In public/community health during epidemics In public/community health during epidemics

11. APN Managed Clinics Professional Requirements Professional Requirements Education Education Knowledge worker Knowledge worker Qualified workforce Qualified workforce

12. APN Managed Clinics Education Education Moved from hospitals to universities -- beyond post-basic Moved from hospitals to universities -- beyond post-basic Scientific advances created knowledge gaps Scientific advances created knowledge gaps Expanded role requires life long learning Expanded role requires life long learning

13. APN Managed Clinics Nurses became knowledge workers* Nurses became knowledge workers* Harnessing the power of theoretical and analytical knowledge Harnessing the power of theoretical and analytical knowledge Technology enhanced business and networking Technology enhanced business and networking Health care consumer is poorly served Health care consumer is poorly served Workforce is redesigned Workforce is redesigned *White, K. & Begun, J. 1998, Nursing entrepreneurship in an era of chaos and complexity, Nrs. Admin. Q. 22, (2); 40-47.

14. APN Managed Clinics Qualified workforce Qualified workforce Qualified students for enrollment Qualified students for enrollment Qualified faculty and approved curriculum Qualified faculty and approved curriculum Health care system open for APNs Health care system open for APNs APN role legitimized APN role legitimized Fiscal support for education Fiscal support for education Patient acceptance of APN role Patient acceptance of APN role

15. APN Managed Clinics Social, Cultural & Legal Contexts Social, Cultural & Legal Contexts Social implications Social implications Womens role in society Womens role in society Trends of health in nation Trends of health in nation Direction of health policy Direction of health policy

16. APN Managed Clinics Cultural influences Cultural influences Perceived role of nurse Perceived role of nurse Employee versus independent provider Employee versus independent provider Risk taking and assertiveness Risk taking and assertiveness

17. APN Managed Clinics Legal context Legal context Legitimate role and Credibility Legitimate role and Credibility Scope of practice and title Scope of practice and title Professional and/or Regulatory competence Professional and/or Regulatory competence

18. APN Managed Clinics If you have the foresight, youre blessed, but if you have insight, youre a thousand times blessed. If you have the foresight, youre blessed, but if you have insight, youre a thousand times blessed.

19. APN Managed Clinics Foundational elements of a APN Managed clinic : Foundational elements of a APN Managed clinic : Mission/Purpose/Philosophy Mission/Purpose/Philosophy Leadership and Management Leadership and Management Fiscal support Fiscal support Professional standards and/or regulations Professional standards and/or regulations Professionals prepared as APNs Professionals prepared as APNs Consumer/patient marketing Consumer/patient marketing

20. APN Managed Clinics Methods for implementing APN Managed Clinics Methods for implementing APN Managed Clinics Business approaches: Business approaches: Entrepreneur or Intrapreneurs Entrepreneur or Intrapreneurs Collaborative practice Collaborative practice Corporations Corporations

21. APN Managed Clinics Entrepreneur or Intrapreneurs Entrepreneur or Intrapreneurs Starting a business focused on health care, alone or with a partner Starting a business focused on health care, alone or with a partner Starting a business within an existing health care facility such as a hospital Starting a business within an existing health care facility such as a hospital

22. APN Managed Clinics Collaborative practice Collaborative practice Working alongside or in partnership with another professional in the business of health care Working alongside or in partnership with another professional in the business of health care

23. APN Managed Clinics Corporations Corporations Independently contract to establish a health service within and existing non-health related corporation Independently contract to establish a health service within and existing non-health related corporation

24. APN Managed Clinics Infrastructure for Implementation of N-MC. Infrastructure for Implementation of N-MC. Know the trends influencing health care Know the trends influencing health care Identify consumers unmet health needs Identify consumers unmet health needs Follow the scientific advances Follow the scientific advances Oversight of fiscal viability Oversight of fiscal viability Monitor health policy changes Monitor health policy changes

25. APN Managed Clinics Infrastructure for implementation Infrastructure for implementation Know the trends influencing health care Know the trends influencing health care Demographic shift of population Demographic shift of population Burden of illness shift Burden of illness shift Provider ratio disparities Provider ratio disparities Pandemics Pandemics

26. APN Managed Clinics Infrastructure for implementation Infrastructure for implementation Consumers unmet health needs Consumers unmet health needs Individual patient Individual patient High Risk populations High Risk populations Target groups Target groups Community Community

27. APN Managed Clinics Infrastructure for implementation Infrastructure for implementation Scientific Discoveries Scientific Discoveries New procedures and medications New procedures and medications Current research Current research Opportunities for focal providers Opportunities for focal providers Caseload management Caseload management

28. APN Managed Clinics Infrastructure for implementation Infrastructure for implementation Fiscal viability Fiscal viability Securing and assuring funds for operation and advancement of clinics Securing and assuring funds for operation and advancement of clinics Research the outcomes of health care Research the outcomes of health care Cost-effectiveness of APNs Cost-effectiveness of APNs Budget and accounting Budget and accounting

29. APN Managed Clinics Infrastructure for implementation Infrastructure for implementation Monitor health policy changes Monitor health policy changes Involvement in policy process Involvement in policy process Monitor trends in governmental resource allocation Monitor trends in governmental resource allocation Policy implications for nursing practice Policy implications for nursing practice Policy changes that affect patient care Policy changes that affect patient care

30. APN Managed Clinics The future of APN Managed Clinics depends on all these factors and the individual commitment to bring about change. Barriers exist, but they can be overcome through leadership, knowledge and collaboration. Success relates to the efforts and energies of all nurses in your community/nation working together to make change. The future of APN Managed Clinics depends on all these factors and the individual commitment to bring about change. Barriers exist, but they can be overcome through leadership, knowledge and collaboration. Success relates to the efforts and energies of all nurses in your community/nation working together to make change.

31. APN Managed Clinics Thank you Thank you Rosemary Goodyear Ed.D, APRN-BC, FAANP Rosemary Goodyear Ed.D, APRN-BC, FAANP rtgoodyear@roadrunner.com