8
Sue: A Corporate–Frontier Challenge
OVERVIEW
Sue grew up in mostly small towns and hails from a family of physicians. After receiving her RN license, she practiced in several locations that included a large metropolitan hospital and a small-town community hospital. She worked primarily intensive care and in the emergency room (ER). One of her moves was to a community in a neighboring state:
I heard about a program in. . . . They were using RNs on their ambulance, as paramedics basically. So we moved there and stayed for almost 2 years in which I gained a lot of experience in the ER and did a few ambulance runs. The nurses were a union organization and would not allow the 24-hour shifts with 12-hour regular pay and 12-hour standby pay, similar to the ambulance crew schedule. As this had not been negotiated before RNs were hired, along with a substantial outlay of money, the program never flew, because the hospital was not going to pay RNs overtime on a 24-hour workday.
While working there, Sue was diagnosed with a chronic medical condition that greatly affected her ability to work. To be closer to family for support, she, her husband, and small children moved to their current community. Sue’s medical condition stabilized and she started working at the local clinic 1 day per week to get her “feet in the door.” Ten years later, she decided to enroll in a nurse practitioner (NP) program where she received a master’s degree.
The community clinic was owned by a group of physicians who staffed the clinic part time. Once Sue had her NP license, she was hired to provide service as an NP and has worked several days per week in that role. A few years ago, the physician group made the decision to sell the clinic to a corporate health care organization, which is located in one of the state’s largest cities, 150 miles away.
As noted in the introduction to Part II, narratives are a snapshot in time. The clinic has undergone significant change as a result of the change in ownership. At times, change brings conflict. Depending upon one’s perspective, change can also have both favorable and unfavorable consequences. These changes and their impact on her practice are the focus of Sue’s narrative.
CONCEPTS
The concept of a frontier culture was discussed in Chapter 1 and examined in Chapter 3. Sue feels that corporate America does not have a basic understanding of the culture of frontier communities:
My biggest struggle right now is that there doesn’t seem to be anyone in this whole, huge corporate thought process who is willing to look at what it means to a small community, when even little changes are made to the delivery of health care. For example, we’ve been told that we can’t put any local communication on our clinic communication board. The corporation does not seem to care what the communication board means to a small community and that it is an important way we communicate with each other. No one took the time to see how this might impact our clinic or that it might produce significant ill will. No person came and asked us, they just said, this is our policy and only what we okay can go on the board. It seems like a small thing, but it’s one of those types of things that undermine trust in a small-town setting. There doesn’t seem to be an effort to understand the small-town culture and that’s more frustrating to me than anything.
Prior to the change in clinic ownership, Sue would overlap a day a week with one of the physicians. This enhanced collaborative practice and gave her a sounding board that decreased her sense of professional isolation. Due to physician turnover, Sue now works days where there is no overlap of provider services. As a result of the change in ownership, the clinic now has an electronic medical record (EMR) system that allows for integration with the larger facility in a different location. The clinic is small and only has room for one provider computer and dictation center, and Sue states that it is not feasible for more than one provider to work at the same time. Therefore, to enhance professional collaboration, Sue is now a preceptor for NP students from various programs around the country. So far she has been a preceptor for four students:
Although I’m a very independent person, I miss the camaraderie of having other people to interact with. You learn so much. Currently my student is an ER nurse and she is a delight. It’s great to have someone to talk things over with. While you’re explaining why you do certain things, you’re validating what you’re thinking and clarifying your own thought processes.
Although the EMR has decreased the availability of local professional collaboration, it has enhanced distance collaboration:
I can message a cardiologist, tell them briefly what’s going on, I can run an EKG on our old machine and scan it in, have it in media on the computer, and say, can you look at this and tell me what’s going on. They’ll get back to me, often in the same day. That did not usually happen prior to the EMR. That piece of being able to actually communicate with specialty providers, that I have a collaborative relationship with, is awesome.
Sue gives another example of how integration has enhanced her ability to coordinate care:
There was a young female patient who wanted to see me but she lives in . . . [over 100 miles away]. She was having a lot of medical problems, migraine headaches, fatigue, and generally not feeling well. She has a history of some liver problems so I decided to order a complete abdominal ultrasound. She had the ultrasound and some lab work done in. . . . I got all those results back an hour later. It was boom, right here. I was able to call her and say, everything looks okay, and I’m over 100 miles away. So that is one of the good things.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
