Entrepreneurship: Nurse-Owned Clinics and Beyond Mobile FNP (Family Nurse Practitioners) There are over 125,000 NPs (nurse practitioners) in the U.S., as per estimates of the AANP (American Academy of NPs). Compared to physician assistants, NPs enjoy greater autonomy and responsibility, and have been increasingly assuming roles in administrative leadership, aside from their conventional patient-care duties at clinics and hospitals. However, owing to the thorough knowledge required to succeed within private practice settings, NPs often establish independent practices after many years of experience at healthcare centers such as hospitals, in the role of salaried NPs (Furlow, 2011).

According to the Chief Executive of the NNCC (National Nursing Centers Consortium), Tine Hansen-Turton, a substantial growth has been observed in nurse-run health clinics, before as well as subsequent to the implementation of the ACA (Affordable Care Act). She claims the number of nurse-run clinics across the nation has now grown to five-hundred; this figure is expected to rise, with providers seeking more cost-effective means of providing healthcare (Toner, 2014). Furthermore, since nurses' salaries are lower than physicians', significant savings can be achieved. Further, they do not hesitate to provide healthcare in areas that are medically underserved (e.g., remote rural localities). Nevertheless, nurse practitioners (NPs) are facing a struggle (Jacobson, 2013). While they are authorized to open offices in places that are medically underserved, their clinic cannot be more than seventy-five miles away from their supervising physician's base. Also, these physicians have to show up at the nurse's clinic no less than once in ten days and review a minimum of 10% of total cases the nurse practitioners handle.

An NP program is being implemented for filling the gaps in underserved urban and rural regions wherein primary care is otherwise inaccessible (Helseth, 2010). NPs can handle between 80% and 90% of physician-handled primary care problems. Just as a primary care doctor refers a patient to a specialist in case advanced care is needed, an NP refers his/her patients to a physician in case a problem arises that lies outside his/her scope of practice. An enormous demand exists for developing this role for the purpose of addressing disease prevention and health promotion needs, as well as providing underserved people with evidence-based healthcare. Aged and homeless individuals without access to means of transport for visiting hospitals and having their medical issues resolved are cared for by these NPs, particularly by mobile family NPs (FNPs). The profession of nursing is increasing in depth as well as breadth. While a few qualified doctors and physicians consider the emerging trend of mobile FNPs and nurse-owned facilities a threat to their profession, doctors and physicians who benefit from such services don't. A debate has been sparked with regard to whether or not these NPs threaten medical care's future, as a global explosion has been witnessed in a number of NPs.

Literature Review

Universal healthcare access, affordable prices, holistic coverage, and superior quality care are the 4 mainstays of the U.S. healthcare reform. The nation's present health care system has been doing well on the quality aspect, passably on the coverage aspect, and disappointingly on the cost and access aspects. Continuously rising co-payments and premiums have rendered health coverage unaffordable to a number of families. Approximately 40 million U.S. citizens have no adequate health coverage. Even those who are insured receive no proper long-term and preventive care services. Yet, the nation's annual healthcare spending is almost a trillion dollars! (Aiken & Sage, 1992, p. 187) Healthcare service utilization is exceedingly wasteful. The above observations indicate a recommendation for change through reduction in healthcare delivery expenditures. The U.S. has an excess of surgical and medical subspecialists, but the number of primary care providers is inadequate. Furthermore, a shortage of healthcare providers has been experienced in several areas across the nation. While 240 doctors exist per 100,000 individuals in the U.S. overall, 23% of the nation's population resides in rural localities with an average of just 67 doctors per 100,000 individuals (Aiken & Sage, 1992, p. 189). Ethnic and racial minorities' health status is worse than the majority citizens' health status, partly owing to absence of efficient healthcare services (Aiken & Sage, 1992, p. 190). Present medical education patterns rather disfavor a number of skills most important for a reformed system of healthcare (Aiken & Sage, 1992, p. 191). Therefore, Sage and Aiken support nursing practice, as their educational ideology is founded on a comprehensive approach to disease prevention and health, contrary to the doctrine of physicians, who mostly receive their training in educational...

In the last few decades, licensed RNs (registered nurses) in the U.S. have grown steadily in number to a whopping 2.9 million. This RN workforce increase has been coupled with a rise in competence and number of highly qualified APRNs (advanced practice RNs). APRNs are nursing professionals with, at the very least, a postgraduate nursing degree, certified by specialty nursing or professional institutions, and authorized to deliver patient care in line with their specialty and state nursing practice scope regulations (Naylor & Kurtzman, 2010, p. 893). Increase in aged and chronically-ill individuals, for instance, intensifies concerns regarding workforce adequacy and the persistent quality lags. Questions pertaining to the primary healthcare system's value, as determined by U.S. performance on several economic indicators, patient experience dimensions, and health outcomes have been voiced, particularly compared with other developed nations.
Outcomes of the research performed by Kurtzman and Naylor (2010, p. 895) are corroborated by the findings of 3 randomized clinical trials and a couple of secondary analyses based on these trials. The findings are additionally supported by no less than 14 further, descriptive researches that compare primary care delivered by physicians and NPs. Care provided by the latter equaled that provided by the former. In fact, in some of these studies, researchers found that NPs delivered better care in terms of chosen measures, compared to physicians. Uniformly, in all studies, it was found that among NPs, no group differences existed when it came to patient health status, prescribing behavior, and treatment practices. Furthermore, consistent better NP results were obtained on the following measures: consultation time; patient follow-up; screening, counseling and assessment; and satisfaction.

The homeless population is identified as one of the vulnerable groups that utilizes extensive healthcare provider services, and contributes significantly to the healthcare system burden. Patients possessing scant resources and unsound housing situations are associated with a greater likelihood of getting re-hospitalized. Service disparity with regard to this group gives rise to a sense of hopelessness, helplessness, and dehumanization. The homeless are usually stigmatized and considered unproductive burdens to society, depending on the state for their overall care. High-risk healthcare system users contribute to the phenomenon labeled as "revolving door syndrome" (Fraino, 2015, p. 39). Mobile healthcare team implementation is aimed at providing continued and extended health services after discharge from hospitals for improving patients' opportunities of residing successfully and independently within their respective communities. Therefore, Opportunity Village Mobile Health is a test initiative created for providing mobile healthcare services to homeless people in California's Marin County when transitioning from hospital to community settings.

MacDonalds & Roots (2014, p.3) performed a research aimed at reporting on a Canadian research's findings for identifying NP role implementation's effects at the level of practitioner, practice, local, and community acute care services, wherein the NPs collaborate with general practitioners within rural FFS (fee-for-service) primary care settings. The authors undertook 3 case studies in which the NPs were integrated into rural FFS services for ascertaining outcomes at community, health service, practitioner, and practice levels. Documents, interviews, and pre- and post- data were evaluated for identifying changes in access, practice, utilization of acute care medical services. Results revealed that care delivery was influenced by NPs, especially through added time devoted to individual patient visits, switch in practice style from independent to team-based practice, and creation of a team-based approach characterized by inter-professional collaboration; this led to improved doctor job satisfaction. Patients' care access increased with increased appointment availability. Also, practice workforce experienced an improvement in their personal job satisfaction and workplace relationships. At the level of community, primary care access for populations that are more difficult to serve witnessed an improvement, and novel community-practice linkages surfaced. NPs' presence increased physician coworkers' inclination to continue working in their present work setting.

Happell, Johnstone and Wortans' research work (2006, p. 80) attempted at exploring recipients' views with regard to the treatment and care received by them from their nurse practitioner candidate (NPC). A qualitative research was employed for testing the expansion of conventional nursing practice in the following four areas: diagnostic testing order, limited psychotropic drug prescription (from a prescribed, limited formulary), authorization of certi-cates for absence from the job, and medical specialist referrals. Seven CATT (Crisis, Assessment and Treatment Team) service consumers accepted the offer to take part in the research. These individuals received treatment and care, standard nursing treatment as well as care related…