I am a FNP student 8 weeks into my first practicum rotation. I'm mostly in a busy clinic office, but twice I was asked to go to a retail clinic. The clinic is staffed by one NP and a receptionist in a moderately busy outlet. The NP is limited to what can be seen and treated, so basically only ENT, GU. No lacerations, suturing, GI, chest, wheezing...you get the idea; Its quite basic. I'm glad for the experience, don't get me wrong..I can spot a sinus infection across the room now:yeah:. There were some things that bothered me about the politics and the prescribing of antibiotics in the retail clinics, and I'd like to get some opinions from working NPs from all clinic areas before I make up my mind on what is right.
Firstly retail clinics are a retail business, and without customers that business, like others, will not succeed. People pay $xx to be treated for whatever illness they have. If they are happy with the service, and perceive it to be of value they will return.
What I have a hard time with is that people except an antibiotic along with their $xx fee, even when it is clearly not indicated. I saw people with no fever, clear sinus drainage, no HA, no cough were diagnosed with a sinus infection (and URI) to justify an ABX. The NP I was assigned to said that is what they expect, and if they don't get it they will go to our competitor up the road. If they go to the competitor we loose revenue, and I loose a job" There was no need for me to mention antibiotic resistance; I could read that she felt uneasy and ashamed about this practice all over her face, and I really felt she was in an ethical dilemma within herself.
So then, here is the issue: Do we prescribe antibiotics without justification in order to ensure customer satisfaction, good community reputation, and return on investment for the parent organization? Or do we help prevent the development/spread of ABX resistant organisms, and hope the patient understands we are doing this for the good of the HC community as a whole, plus saving them from possible SE of the ABX? (remember, most of these people are uninsured and pay out of pocket)
I suppose one could refund their money if they do not Rx an ABX. This would satisfy the customer monetarily and increase trust in the clinic, but then the NP is not making the clinic money, and less business income means over time equals closed doors and unemployment lines.
I would love to hear all sides of the issue. I will likely end up working in one of these clinics at some point, but will I compromise my clinical work ethic for the sake of a having a job? I've been an ICU and ED nurse since 1997, and I have always worked to protect my patients, even when it ended me in hot water...I was doing my job as a patient advocate.
One more issue...the dark side ...I notice in my geographical region there are NO physicians that run these retail clinics, in fact they removed clinic services from the local ED's. Given the scenario presented could the retail clinic undermine NP validity in the eyes of physicians, and is this intentional?
I appreciate all feedback.
