Nurse-managed clinics come of age, move into the mainstream

On their own
Nurse-managed clinics come of age, move into the mainstream

By Megan Malugani
November 13, 2000
Photo: Artville

Nursing centers are increasingly offering primary care and expanding their patient base.


	You've read the article. Now tell us what you think. For more information An updated version of Karon White Gibson’s book, Nurses: On Our Own, will be available on www.iUniverse.com. The National League for Nursing disbanded its Council on Nursing Centers, but the Regional Nursing Centers Consortium, an association of nursing centers in Pennsylvania, New Jersey and Delaware, is leading efforts to make nursing centers more visible and credible. Call (215) 951-0330, Ext. 140.

A century after Lillian Wald established the Henry Street Settlement and Margaret Sanger opened the first birth control clinic, nurse-managed clinics have become an integral part of the nation’s health care system.

Nursing centers, as they are now called, still provide care for the indigent, and nurses still staff Planned Parenthood clinics. But the country’s 300 nursing centers also have evolved in new directions in modern times.

Spurred by the necessity to be financially self-sufficient and the broadening scope of practice of nurse practitioners, nursing centers are increasingly offering primary care as well as preventive health services, and expanding their patient base.

The University of Rochester in New York opened the first modern nursing center in 1965 after the passage of the Nurse Training Act of 1964, which made federal funds available for the training of advanced practice nurses, said Jo Brooks, DNS, RN, former chair of the National League for Nursing’s Council on Nursing Centers, which recently disbanded.

The University of Rochester’s goal was to fill a void in the community by "creating a place where [nursing] faculty could function as role models for students," said Brooks, director of the Purdue University-affiliated Family Health Clinic of Carroll County in Delphi, Ind., and professor emeritus at the Purdue University School of Nursing.

Throughout the 1970s and 1980s, many nursing schools received federal grants to launch nursing centers, Brooks said. In addition, nurse entrepreneurs opened freestanding nursing centers, and hospitals launched nursing centers as more cost-effective alternatives to their emergency departments for patients.

Karon White Gibson, RN, and Marcia Joy Smith Catterson, RN, founded a freestanding nursing center, Registered Professional Nurses, in Palos Hills, Ill., near southwest Chicago, in 1973. "It was unbelievably difficult when I look back, but we forged ahead," Gibson said.

Becoming visible in the community and building a client base were the biggest challenges, said Gibson, who co-wrote a book about the experience called On Our Own (1981, St. Martin’s Press and Avon Paperbacks).

Within a few years of opening their doors, however, Gibson and Catterson not only were caring for a broad range of walk-in patients at their center, but also were providing first aid at indoor amusement parks and on movie sets. Although Gibson now is a television producer and host, she reflects fondly on her days as a nursing center pioneer.

"I’ve never been able to experience the same kind of instant gratification. We made our own decisions with no bureaucracy to deal with," Gibson said. "If someone needed something, we did it."

Nursing centers have changed a lot since the University of Rochester project and Gibson’s entrepreneurial days, experts said. The Community Health Services Clinic in Scottsdale, Ariz., reflects this evolution.

The clinic, which is affiliated with Arizona State University’s College of Nursing, opened in 1977 with a million-dollar grant from the U.S. Department of Health and Human Services’ Division of Nursing. Its goal was "to provide a service to the community, to be a site for student and faculty practice, and to evaluate what nursing could accomplish in the community," said Elizabeth Holman, MS, RN, the clinic’s director.

In the beginning, ASU’s nursing center primarily served the indigent population and was dependent on grant funding, Holman said. Twenty-three years later, however, about half of the patients served at the clinic have insurance, and the nursing center "has evolved into a little business that’s basically self-sufficient," she said. The center has broadened its scope to stay afloat financially.

"Too many academic nursing centers have failed after grant monies have dried up because they’re still taking care of only the indigent population," Holman said.

Last year, the ASU nursing center’s staff of nine – which includes nurse practitioners, RNs and clerical workers – had 3,500 patient encounters inside the clinic and 3,500 encounters in other settings such as health fairs and schools.

The clinic has several contracts with organizations and businesses in the community, too.

For example, the staff conducts physicals on newly admitted patients at a nearby psychiatric hospital, and they also conduct pre-employment physicals for the university. The changing focus of the ASU nursing center is typical, Brooks said.

"Nursing centers offer more primary care now because you tend to do what you can get reimbursed for," she said. "And the fact that more nurses are coming out of family nurse practitioner programs and can offer primary care has enabled nursing centers to really expand."

The University of Texas-Houston Health Science Center School of Nursing’s nursing center also prides itself on economic self-sufficiency. Opened in 1989, UT Health Services offers some care to traditionally underserved populations, but focuses more on occupational health and primary care for the employees of local companies and organizations.

Thomas Mackey, Ph.D., NP, director of UT Health Services and professor of clinical nursing, pounds the pavement to secure contracts with clients ranging from Union Pacific Railroad to other local universities.

"It’s important for us to show our students that a nursing center can be a viable business," Mackey said. "Nurses have taken care of poor people and those out of the mainstream for centuries. We feel that it’s important to demonstrate that nurses not only take care of poor people, but everybody."

Mackey’s staff consists of a family nurse practitioner who specializes in women’s health care, a geriatric nurse practitioner, an infection control nurse, a health educator, two licensed vocational nurses, a medical assistant and two receptionists. Two physicians work at the center a half day every week, Mackey said.

As the UT-Houston HSC and ASU nursing centers reflect, successful nurse-managed clinics continue to evolve and diversify their revenue streams to stay afloat.

Despite constant budget concerns, the future looks bright for nursing centers as they continue to gain popularity among insured people who will pay out-of-pocket for longer appointments and individualized attention, Brooks said.

"Most nursing centers start out serving the underinsured and the uninsured, but then others in the community find out what great places they are and choose to go there," she said.