Building a Sustainable Nurse-Managed Clinic System Through Faculty Practice and Technology Integration

Wednesday, 1 August 2012: 8:50 AM

Julie Cowan Novak, DNSc, RN, MA, CPNP, FAANP
School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX

Learning Objective 1: Describe steps to integrate faculty practice, student learning, access to research populations, and community engagement through comprehensive care in nurse-managed clinics.

Learning Objective 2: Analyze outcomes related to access, cost, child and family health, EHR, workforce, ER diversion, quality, and safety in an innovative nurse-managed clinic system.


Over the past four years, the UTHSCSA School of Nursing has developed, implemented, and evaluated a viable alternative to the failing, mismanaged US healthcare delivery system. Two nurse-managed clinics are currently in operation with two in development. Client visits exceeded 7,000 in 2011.  The clinics are sustained through a mosaic of support from a variety of funding sources including private, state and federal insurance, billing, and grants.  Faculty and students develop an integrated model of discovery, learning and engagement focused on evidence-based health promotion/disease prevention, client, family, and community education, acute, episodic illness care, management of stable chronic conditions and emergency room diversion.  Quality and safety outcomes are measured.  Electronic health record adoption and integration was completed in 2011 at all sites.


This model maintains a strong focus on care of the vulnerable and underrepresented, including the Latino population in San Antonio/South Texas (50-90%), a Head Start (birth to five) population, comprehensive student health, and employee/occupational health (Novak in Yih, 2011).  Of the 683 US nursing schools, approximately 17% are engaged in some form of faculty practice or nurse-managed clinic development, an increase over the past decade (AACN, 2010).  EHR implementation in resource-limited primary care settings, including nurse-managed clinics, promotes care continuity (Dennehy, 2011).  Consortia of academic nurse-managed clinics and faculty practice integration continue to grow due to primary care access needs and positive quality indicators (Pohl, 2010).


This nurse-managed clinic model proposes an accessible, cost-effective, efficient, high quality evidence-based system of primary healthcare education, and research with the application of engineering principles, optimal use of EHR technology, and faculty practice.  Advanced Practice Nursing faculty and students are uniquely positioned to further change the face of local to global healthcare with added expertise in systems approaches and removal of practice and policy barriers.