4. Re-establishes Trust Within the Community 
Provides an Economic Oasis 
Unilaterally Beneficial 
Full Family Practice 
Patient Education & Health Promotion 
Reduction in Emergency Room Overcrowding 

6. Emergency
Room
Overcrowding
Patient
Dumping
Delay in
Admission
Non-
Urgent
Medical
Care
Nursing
Staff
Affected
Close
Until
Space is
Available
Patient
Outcomes
Affected

7.  Support Overall Change in Health Care
Seeking Patterns
 Accessible to All Involved
 Generate Broad-Based Slogans for
the Public
 Focus on Specific Groups & Topics

8. The Nurse Will See You Now
Immunization –
Give Your Child A Chance

9. 
Recommends Clinics have Physician Supervision
(States actually set their own rules)

Nurse Practitioners out of Scope of Practice
Bypassing Conventional Boundaries
Fear of Losing Business

11.  Community Advertising
August 2013 – Ongoing
 Renovation/Construction
August 2013 – August 2014
 Vendor Selection
June 2013 – Ongoing
 Staff Hiring
June 2013 - Ongoing
 Project Proposal
April 2012
 Final Corporate Approval
April 2013
 Site Selection
April 2012 – June 2013
 Contractor Bidding
June 2013 – August 2013
Grand Opening
September 2014

12. 20 Bed Facility 5000+ Patients/Yr 50-60 Full Time Professionals
Patient to Nurse Ratio – 4:1 30 Part Time Professionals

13. 78%
6%
1% 12%
3%
Contractor
Computers
Exam Tables
Hospital Beds
Office Furnishings

14. 30%
61%
2% 1%
6% Support Staff
Medical Staff
Building Lease/Yr
Pyxis MedStation Lease/Yr
Pharmaceuticals & Medical
Operating Expenses

15. Less
Overcrowding
in the ER
Positive
Patient
Outcomes
Effective
Staffing
Impact on
Science of
Nursing
Improved
Community
Health

17. American College of Nurse Practitioners, (2009). AMA scope of practice data
series. Nurse practitioners. Retrieved from www.acnpweb.org/files/
public/08-0424_SOP_Nurse_Revised_10.09.pdf
Cowen, R.M. & Trzeciak, S., (2005). Clinical review: Emergency department
overcrowding and the potential impact on the critically ill. Critical Care,
9(3), pp. 291-295
Haddad, H., (2004). Factors related to overcrowding in the emergency
department. Virginia Henderson International Nursing Library. Retrieved
from http://www.nursinglibrary.org/vhl/handle/10755/160252
Howard, M.S., Davis, B.A., Anderson, C., Cherry, D., Koller, P. & Shelton, D.,
(October, 2005). Patients’ perspective on choosing the emergency
department for non-urgent care: A qualitative study exploring one reason
for overcrowding. Journal of Emergency Nursing, (31)5, pp. 429-435:
Elsevier. DOI: 10.1016/j.jen.2005.06.023

18. Johnson, K., & Winkelman, C., (2011). The effect of emergency department
crowding on patient outcomes: A literature review. Advanced Emergency
Nursing Journal, (33)1, pp. 39-54. January/March, 2011. Lippincott
Williams & Wilkins, Inc. DOI: 10.1097/TME.0b013e318207e86a
Kilcoyne, M. & Dowling, M., (September, 2007). Working in an overcrowded
accident and emergency department: Nurses’ narratives. Australian
Journal of Advanced Nursing, (25)2, pp. 21-27
Loviglio, J., (February, 2011). Nurse practitioners filling care void. Joy Medical
group. Retrieved from https://joymedicalgroup.com/news-detail.aspx?11
Mosby, (2006). Patient dumping. Mosby’s Dictionary of Medicine, Nursing &
Health Professions, 7th Ed., p. 1412. Elsevier: St Louis, MO
Sullivan, M., (2011). Organizational theory and design. Villanova University
course material. Retrieved from http://www2.homepage.villanova.edu/
Maureen.sullivan/coursematerial/L&M_Notes/Organizational_Theory_and_
Design.htm

19. Tanabe, P., Gisondi, M., Medendorp, S., Engeldinger, L., Graham, L.J., &
Lucenti, M.J., (August, 2008). Should you close your waiting room?
Addressing ED overcrowding through education and staff-based
participatory research. Journal of Emergency Nursing, (34)4,
pp. 285-289: Elsevier. DOI: 10.1016/j.jen.2007.08.009