Why They Leave

For a better picture of this phenomenon, ADVANCE for Nurse Practitioners conducted an informal online poll asking NPs who worked in convenient care about their length of employment there. The majority said they'd stayed between 6 months and 2 years, mirroring what other NPs reported about their length of stay (see figure).

The primary reason NPs leave appears to be restriction on scope of services. Erin Mitchell-Colligan, NP, was a new grad when she took a job in convenient care.

"I actually enjoyed the autonomy, but after about 6 months, I got bored with treating the same ENT stuff over and over," she recalled. She also felt it was difficult to learn from patient experiences because of limited follow-up. She considers convenient care a good spot for an NP who wants a change, but not a good position for new NPs because growth is limited. "I really just felt like my knowledge was being wasted with such a limited scope," she said.

Beth Gillis, NP, was offered a position in convenient care but turned it down after obtaining details. "We were permitted to check for high cholesterol and blood pressure, but not allowed to treat it. Many people confuse 'scope of service' with 'scope of practice.'"

Some NPs said they left convenient care because they felt isolated. Although the work day can be busy, the nature of episodic care means that NPs cannot establish personal connections with most patients.

Why They Stay

Of course, many NPs in convenient care are happy. Lindi McGaughy, NP, who works at a Take Care Clinic in Columbus, Ohio, says she enjoys her work there.

"I treated the same things over and over in primary care, too ... just part of the job." She cites autonomy and the company's support system as reasons to stay. She also says she appreciates the chance to encourage patients to establish care with primary care providers. "And we even save lives," she says. "Boy, do I have some stories!"

Heather Goodall, NP, has been working in a convenient care clinic inside Walmart for about 6 months. She says she's pleased with the positive feedback she's received from patients, and she plans to stay. She believes frequent turnover can be attributed to the number of tasks NPs must perform in this setting.

"I am disappointed to see all the surveys out about salaries - mine is much lower - and I wear a lot of different hats," she said. "The turnover of NPs is high because of this; they have to learn and juggle so much more than just patient care: writing school and work excuses, cleaning, billing and coding, entering insurance info, balancing daily deposits.

"I spend a lot of time on education, and at first I wondered if this was making an impact," Goodall explained. But when patients started returning to tell her they'd found a primary care provider, made diet changes or quit smoking, she was reassured that she'd made a difference for them.

Sandra Ryan, chief nurse practitioner officer for Take Care, points out that most Take Care locations opened in 2008, meaning that little data are available about retention. She said NP turnover in Take Care clinics is close to the rate of NP turnover as a whole. Many of the NPs she hired to start the company's first 50 clinics are still with Take Care, she added.

"Obviously turnover rates are something every company should measure," Ryan said. Some turnover is good turnover, when NPs who aren't a good fit for the model leave. "Other turnover is what we call 'regrettable turnover,' and that's what we really want to look at." She wants NPs who work for Take Care to be satisfied with their jobs, because when they are happy, patients are happy - the goal for NPs as well convenient care operators.

Reducing 'Regrettable' Turnover

Ryan said the limited range of services NPs can provide in clinics is their biggest concern, "so expanding scope and having more services is going to be a retainer."

Turnover is an undeniable concern. If convenient care clinics hope to establish a relationship with their communities, the providers should be familiar faces. As convenient care continues to expand in scope, clinics could closely approximate primary care clinics, and NP concerns about scope and continuity of care could dissolve.

Jennifer Ford is the associate editor and our convenient care columnist. Reach her at jford@advanceweb.com.