The Advanced Practice
Nurse Managed Clinic:
Nurses Responding to Change
Rosemary Goodyear Ed.D, APRN-BC,
FAANP
APN Managed Clinics:
Nurses Responding to Change

Identify the professional requirements
for operating an APN managed clinic

List the social, cultural and legal
implications of establishing an APNMC

Discuss the potential of this method of
providing health care within the
nation’s current health care system
APN Managed Clinics
 Foundational
elements of a APN
Managed clinic:
 Mission/Purpose/Philosophy
 Leadership
and Management
 Fiscal support
 Professional standards and/or
regulations
 Professionals prepared as APNs
 Consumer/patient marketing
APN Managed Clinics
MissionPurpose-
Philosophy-
APN Managed Clinics
Leadership
Management
APN Managed Clinics
Fiscal
Support
APN Managed Clinics
Professional
Regulations
Standards
APN Managed Clinics
APN
Preparation
APN Managed Clinics
Consumer/Patient
Marketing
APN Managed Clinics

History of nurses managing health care
independently and interdependently:
In home during child birth and plagues
 In wars caring for the soldiers
 In public/community health during
epidemics

APN Managed Clinics
 Professional
Requirements
 Education
 Knowledge
worker
 Qualified workforce
APN Managed Clinics

Education
 Moved
from hospitals to universities -beyond post-basic
 Scientific advances created knowledge
gaps
 Expanded role requires life long learning
APN Managed Clinics

Nurses became “knowledge
workers”*
 Harnessing
the power of theoretical and
analytical knowledge
 Technology enhanced business and
networking
 Health care consumer is poorly served
 Workforce is redesigned
*White, K. & Begun, J. 1998, Nursing entrepreneurship in an era of
chaos and complexity, Nrs. Admin. Q. 22, (2); 40-47.
APN Managed Clinics
 Qualified
workforce
Qualified students for enrollment
 Qualified faculty and approved curriculum
 Health care system open for APNs
 APN role legitimized
 Fiscal support for education
 Patient acceptance of APN role

APN Managed Clinics
 Social,
Cultural & Legal
Contexts

Social implications
 Women’s
role in society
 Trends of health in nation
 Direction of health policy
APN Managed Clinics
 Cultural
influences
 Perceived
role of nurse
 Employee versus independent provider
 Risk taking and assertiveness
APN Managed Clinics
 Legal
context
 Legitimate role and Credibility
Scope
of practice and title
Professional and/or Regulatory
competence
APN Managed Clinics
“If
you have the foresight,
you’re blessed, but if you
have insight, you’re a
thousand times blessed.”
APN Managed Clinics
 Foundational
elements of a APN
Managed clinic:
 Mission/Purpose/Philosophy
 Leadership
and Management
 Fiscal support
 Professional standards and/or
regulations
 Professionals prepared as APNs
 Consumer/patient marketing
APN Managed Clinics
 Methods
for implementing APN
Managed Clinics
 Business approaches:
 Entrepreneur
or Intrapreneurs
 Collaborative practice
 Corporations
APN Managed Clinics
 Entrepreneur
or Intrapreneurs
 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
APN Managed Clinics
 Collaborative
 Working
practice
alongside or in partnership
with another professional in the
business of health care
APN Managed Clinics
 Corporations
 Independently
contract to
establish a health service within
and existing non-health related
corporation
APN Managed Clinics
 Infrastructure
for Implementation
of N-MC.
 Know
the trends influencing health
care
 Identify consumer’s unmet health
needs
 Follow the scientific advances
 Oversight of fiscal viability
 Monitor health policy changes
APN Managed Clinics
 Infrastructure
 Know
for implementation
the trends influencing health
care
 Demographic
shift of population
 Burden of illness shift
 Provider ratio disparities
 Pandemics
APN Managed Clinics
 Infrastructure
 Consumer’s
 Individual
for implementation
unmet health needs
patient
 High Risk populations
 Target groups
 Community
APN Managed Clinics
 Infrastructure
 Scientific
 New
for implementation
Discoveries
procedures and medications
 Current research
 Opportunities for focal providers
 Caseload management
APN Managed Clinics
 Infrastructure
 Fiscal
for implementation
viability
 Securing
and assuring funds for
operation and advancement of clinics
 Research the outcomes of health care
 Cost-effectiveness of APNs
 Budget and accounting
APN Managed Clinics
 Infrastructure
 Monitor
for implementation
health policy changes
 Involvement
in policy process
 Monitor trends in governmental
resource allocation
 Policy implications for nursing practice
 Policy changes that affect patient care
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.
APN Managed Clinics
 Thank

you
Rosemary Goodyear Ed.D, APRN-BC,
FAANP
rtgoodyear@roadrunner.com