After years of fighting for the authority to practice independently, some of Minnesota's highly skilled nurses will soon lead their own primary care clinic.
On April 6, the University of Minnesota School of Nursing will open a new nurse practitioner clinic in the Downtown East neighborhood across the street from the new Minnesota Vikings stadium and a half block from a light rail stop.
For years, advanced practice registered nurses have served as primary care providers for many patients. Nurse practitioners, nurse midwives, clinical nurse specialists and nurse anesthetists diagnose illnesses, provide treatment and prescribe medications.
But they were required to have a written agreement with a physician to practice. That requirement would sometimes limit where and when they could work based on the availability, and willingness, of physicians to sign the agreements.
That changed on Jan. 1, when a new state law that allows advanced nurses to practice independently took effect. It allows them to break free of from physician oversight after completing 2080 hours of supervised work.
"This is a magnificently empowering time for nurse practitioners in the state of Minnesota," said Connie White Delaney, dean of the University of Minnesota School of Nursing.
The University of Minnesota Health Nurse Practitioners Clinic is modest in size, but its backers say it will help ease a primary care provider shortage and reduce health care costs for lower-income residents in subsidized housing near the intersection of Interstate Hwys. 94 and 35. The rapidly growing Downtown East area also includes upper-income residents who live along the riverfront in the nearby Mill District.
Delaney said two or three nurse practitioners will work in the clinic, where they will treat minor conditions like fevers and flu, and manage patients with chronic illnesses such as diabetes or heart failure.
"It has everything that you would see in other providers' clinic visits," she said.
The clinic already has an agreement to work closely with clients at Emanuel Housing, a 101-unit transitional housing facility for previously homeless people. The clinic occupies a street-level corner in the same building.
Clinic director Jane Anderson said the clinic's nurse practitioners intend to offer wellness classes to clients at Emanuel because disease prevention is a hallmark of nursing work.
"We'll be able to help them understand how to access primary care, so they don't feel like they have to go to the emergency department for every care," Anderson said.
Dan Cain, president of RS Eden, the Minneapolis-based nonprofit that operates Emanuel Housing, tried to lure a physician clinic to the building last year, but was told that the office space was too small. He sought a collaboration with U of M's School of Nursing after a member of his staff suggested he invite nurses to run the clinic instead.
Cain said his clients face many barriers as they try to turn their lives around. Health care should not be one of them, he said.
"You know, some people have had doctors; others have relied on the emergency room," he said. "But none have had the easy access that I think will come from having the clinic right there at that location."
But some physicians aren't sold on the idea of nurse-led clinics.
"Doing things that fragments care rather than coordinates care is always worrisome to us," said Dr. Dave Thorson, president-elect of the Minnesota Medical Association.
Thorson, a family physician in White Bear Lake, said nurses don't have as much training as primary care physicians. He wonders if they will be able to recognize the limits of their knowledge when they're working independently.
"The problem is going be when you get complex illnesses that go across organ systems that require a deeper training, if they're going to be able to recognize that and coordinate care with a physician," he said.
Nurse practitioners at the new Minneapolis clinic say they have good relationships with many physicians and they will refer complex cases to them. The nurses also say they have added pharmacists to their staff to help them manage medications for patients with multiple health conditions.