Years ago, Marjorie Rendell, the first lady of Pennsylvania, was playing with one of her beloved golden retrievers and was accidentally bitten between her thumb and forefinger. She couldn’t close the wound and the doctor’s office was closed, so she headed for the nearest emergency department.
She waited for several hours until a physician was able to see her, administer a few very expensive stitches, and send her on her way.
If Rendell had been able to go to a nurse-led health clinic, instead of an emergency room, she would have been able to save a considerable amount of time and money, according to her husband, Pennsylvania Gov. Ed Rendell.
Rendell touted the promise of nurse-led clinics at a May event marking his new role as chair of the Advisory Council of Raise the Voice, a campaign funded by the Robert Wood Johnson Foundation (RWJF) and a project of the American Academy of Nursing (AAN) that seeks nurse-led and nurse-designed solutions to health care challenges. Providing community-based care through the services of nurses, nurse practitioners and other professionals is one of the projects supported by Raise the Voice.
Today, hundreds of thousands of other Pennsylvanians have an alternative to expensive and time-consuming emergency department visits when minor ailments arise. That is thanks to a series of legislative initiatives Rendell has championed as governor that have freed up nurses to practice to a fuller extent of their abilities.
Now, instead of going to an emergency department, patients with non-emergency conditions can go to one of the dozens of nurse-led centers that have sprung up across the state in the wake of the nursing-related bills signed into law by Rendell.
In 2007, Rendell signed into law the Prescription for Pennsylvania, a set of initiatives designed to improve access to high quality, affordable health care in Pennsylvania. Among those initiatives are laws that lift practice restrictions on nurses; these laws have supported the rise of nurse-led clinics in his state.
“We looked at every potential way to increase access and increase affordability and one of the things we found…was that nurses could be an answer to a lot of those problems,” Rendell explained at a December 9 forum in Philadelphia held by the Initiative on the Future of Nursing, a two-year effort of the Institute of Medicine (IOM) and the Foundation to find solutions to challenges facing the nursing profession.
Now in his final year as governor, Rendell is championing these kinds of clinics in his new position with the Raise the Voice Advisory Council, a post previously held by Donna Shalala, Ph.D., A.B., president of the University of Miami in Florida and the former head of the U.S. Department of Health and Human Services (HHS) under President Clinton.
“The secret weapons to increasing access and affordability are nurses, nurse practitioners and physician assistants,” he said upon taking the Raise the Voice Advisory Council post.
Nurse-Led Clinics Offer Quick, Comprehensive and Affordable Care
Unlike other non-emergency care settings, retail nurse-led clinics are open after normal business hours and on the weekends. They offer quick, comprehensive and affordable primary care services. And no appointments are needed.
Often located in “big-box” discount chain stores, supermarkets and pharmacies, these so-called “minute clinics” are especially valuable to patients who live in rural areas and have a hard time accessing physician care. They also serve low-income, uninsured or underinsured patients who can’t afford the high cost of physician services.
Proponents say these centers will help offset problems that arise from a physician shortage as the population ages and as millions more people enter the health care system as health reform is implemented.
The laws enacted in Pennsylvania allow certified registered nurse practitioners to order home health and hospice care; order durable medical equipment; issue oral medical orders; make referrals to health therapists; perform disability assessments; perform and sign methadone treatment evaluations; and issue homebound schooling certifications.
The new laws also give certified nurse midwives the power to prescribe drugs; define licensing and education requirements for clinical nurse specialists; and empower physician assistants and dental hygienists to take on more responsibilities.
Together, these laws created a supportive environment for the growth of nurse-led clinics, according to Tine Hansen-Turton, M.G.A., J.D., CEO of the National Nursing Centers Consortium and an Edge Runner with Raise the Voice. There are now 41 retail clinics in Pennsylvania, which have diverted thousands of people from all socioeconomic backgrounds away from emergency departments, Hansen-Turton says.
There are also 25 nurse-managed clinics in the state. These types of centers tend to serve more vulnerable populations and are supported mainly by academic and non-profit organizations, according to Hansen-Turton.
The numbers of both types of nurse-led clinics are expected to grow.
As a result of the clinics, the number of visits to emergency departments is down, as is the overall cost of specialty care, prescription drugs, and the average number of days non-maternity patients spend in the hospital, according to the National Nursing Centers Consortium.
Rendell has since promoted the growth of nurse-led clinics, Hansen-Turton said. He and his allies have already seen success; the federal health reform law passed earlier this year authorizes $50 million to support innovative safety-net providers such as nurse-led health clinics. And the U.S. Department of Health and Human Services announced earlier this month it would invest $15 million to support the operation of nurse-practitioner led health clinics.
As head of the Raise the Voice Advisory Council, Rendell is expected to continue to promote nurse-led clinics. One immediate goal, Hansen-Turton said, is to make sure that Congress appropriates the full authorized amount to ensure that the number of nurse-led centers nationwide—which stands at some 250—continues to grow.
“With an expected 31 million newly insured people and a national physician shortage, we're going to need nurses to help meet the basic health care needs of all Americans,” Hansen-Turton said.