The Nurse Practitioner Will See You Now

Laura A. Stokowski, RN, MS


June 29, 2010

In This Article

The Nurse-Managed Health Center

The Patient Protection and Affordable Care Act also designates grants for nurse-managed health centers. Currently, nurse-managed health centers are uncommon, but the hope is that NPs will establish more of these safety net programs, particularly for underserved populations.

Megan Eagle, MSN, FNP-BC, is 1 of 7 NPs and nurse midwives working at the University of Michigan School of Nursing Nurse-Managed Health Centers, based in Ann Arbor, Michigan. Eagle explained the principle of the nurse-managed health center, helmed by an NP.

"We decide what programs we will offer, what our priorities will be. For example, we decided that to provide really comprehensive care, we needed to have a social worker on staff, and we have done so. We decide how many patients we will see, how long our appointments will be, and what other resources we need. In a conventional primary care setting, the NPs wouldn't necessarily be making these kinds of decisions." The health center also bill insurances, and the NPs are listed as primary care providers on numerous insurance and health plans.

"It's a common misconception that 'nurse-managed' means we are completely autonomous, that we don't ask for advice from our physician colleagues when we need their input. This is far from the truth. We have a collaborating physician who is available 24 hours a day by telephone for consultation, and we also consult with other NPs and physicians. In addition to discussing cases and offering advice, our collaborating physician performs the requirements of Michigan law, such as writing prescriptions for certain medications."

What are the advantages of a nurse-managed health center as a medical home? Ms. Eagle explains that "it's a role that NPs play very well: We provide patient counseling and advocacy and practice mutual decision-making. We are doing the coordination piece, the case management that is needed for chronic problems. We communicate with the specialists, we make sure patients understand their test results -- it's a skill that comes from our nursing background."

Most of the health center's new patients come from word-of-mouth referrals. Patients are very satisfied and come back even after they've moved out of the area, and they refer their friends and family members to the health center. They feel listened to. The patients are diverse and from all walks of life -- a homeless patient and a university administrator might be in the waiting room.

The downsides to the nurse-managed health center, from Eagle's perspective, are minimal and are related to the practice restrictions mandated by law or reimbursement policy. "The one thing that annoys me, every single day, is not being able to order home care or durable medical equipment. When a patient of mine is discharged from the hospital and needs a nebulizer, he needs it now. I even have to call someone to get an order for a walker. It makes no sense and is not based on any evidence; care would just be better and more cost efficient if we didn't have that extra step." Eagle also misses working with a larger multidisciplinary team. In her current setting, Eagle is usually the only NP in the clinic on a given day, a shortcoming that is not necessarily related to the health center being nurse-managed but instead stems from the physical size of the 2-examination room clinic.


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