When Lindsay Munden ’13 DNP, RN, FNP-BC joined the College of Nursing and Health Professions faculty nearly five years ago, her reputation preceded her. She’d completed both her M.S. in nursing and doctor of nursing practice at Valpo. Now, Professor Munden teaches, mentors, and inspires students in and outside the classroom, utilizing her nurse practitioner position at CVS MinuteClinic as a means to further enhance student learning.
“Valpo has always been home,” Professor Munden says. “While it’s been quite a transition going from student to professor, everyone has been extremely welcoming. I feel really connected with this University.”
At Valpo, Professor Munden has taught a variety of classes in the doctor of nursing practice (DNP) program and mentored DNP students throughout their capstone evidence-based practice projects. She also maintains her clinical expertise as a family nurse practitioner in the retail health care setting at CVS MinuteClinic. Walk-in medical clinics have many positive aspects — accessibility, flexibility of hours, affordability, diversity of services — not to mention caring and knowledgeable staff. The CVS MinuteClinics are the largest employer of nurse practitioners nationwide.
“Working at the MinuteClinic can make for a long day, but it’s really amazing because it’s something the community needs,” Professor Munden says. “When I was finishing at Valpo, retail health was really starting to boom. My Valpo experience drove me to want to give back and care for the community in this way.”
From examination and lab tests, to diagnosis and coordination of care, to check-in and billing, Professor Munden’s responsibilities at MinuteClinic are all-encompassing and often performed without support staff. She generally sees 20 to 30 patients daily, providing a continually expanding range of services. MinuteClinics were developed with a focus on minor illness and injury but have begun to emphasize wellness and prevention, extending their treatment to address their clients’ needs and utilizing the skills of the nurse practitioners they employ.
“Everything I do each day I’m in the clinic is based off of skills and principles I’ve learned here at Valpo,” Professor Munden says. “From underlying pathophysiology to how I look in someone’s ear, Valpo’s impact is profound. On-campus resources like the Virtual Learning Center continue to be helpful for me in practicing my skills and learning changes in health care.”
Going into retail health was not a decision Professor Munden made lightly. She worried that this sort of practice would limit her ability to form relationships and rapport with patients due to lack of continuity of care. In reality, she serves as the primary provider for many of her patients.
Thanks to Professor Munden’s tenacity, Valpo and MinuteClinic have contracted to provide students clinical experience at MinuteClinic sites across the nation. Spring 2018 was the first semester Valpo students had the chance to get clinical hours in retail health, and eight students embraced the opportunity, two of them working directly with Professor Munden.
According to Professor Munden, one aspect of MinuteClinics that attracts students is autonomy of practice. In Indiana, nurse practitioners are required to have a collaborative agreement with a physician where the physician reviews 5 percent of the nurse practitioner’s charts per week. At MinuteClinics, this relationship allows the nurse practitioners to call upon their collaborating physician with questions or for advice and guidance when needed, but the physician presence is much less than in many other health care settings.
“Nurse practitioners in retail health serve as the sole provider of care, which advances and promotes the nurse practitioner role,” Professor Munden says.
The emergence of retail health has been met with some opposition. Professor Munden read an article revealing that physicians view retail clinics as a business threat, a disruption to continuity of care, and a place where medicines are often inappropriately prescribed and antibiotics overused. This prompted her, along with Julie Koch ’11 DNP, RN, FNP-BC, FAANP, assistant dean of graduate nursing and assistant professor of nursing, to engage in research of their own, primarily examining the perception of retail clinics by nurse practitioners who work with these physicians in primary care settings.
With strong student interest in the launch of preceptor experiences at MinuteClinics across the nation, this research was of particular significance to Assistant Dean Koch, who oversees clinical experiences in Valpo’s DNP program. The research showed some striking dissimilarities, including that nurse practitioner care in retail health is often equal to or better than primary care physicians in terms of patient satisfaction and that nurse practitioners adhere more frequently to evidence-based guidelines and are not contributors to the overuse of antibiotics. The nurse practitioners surveyed did not view their role in retail health as a business threat.
Based on this, Assistant Dean Koch and Professor Munden wrote an article, “Nurse Practitioners’ Perceptions of Retail Health Clinics,” expected to be published in the Indiana Professional Licensing Agency’s Nursing Focus Magazine in July.
In the future, Professor Munden would like to continue to tie her practice to her scholarship at Valpo. As MinuteClinics begin to offer treatment of more chronic conditions, she hopes to evaluate both patients and providers to uncover how care is perceived and determine if treatment is appropriate with positive patient outcomes.