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Running head: TRAVERSE COMMUNITY DIABETIC SERVICES 1

Traverse Community Diabetic Services

Ferris State University

Cheryl Howard, Stephanie Monroe, Michol Popp, Michelle Rowe, Alyson Swinehart

TRAVERSE COMMUNITY DIABETIC SERVICES 2

Abstract

Diabetes is a serious and complicated disease that affects many in Grand Traverse and

surrounding counties. After an assessment of the external and internal environment, it was

determined that there was a need for a diabetic clinic that provides services both to inpatients and

outpatients. Therefore, through careful consideration, the Traverse Community Diabetic

Services has been developed with a mission statement of providing exceptional diabetes

education, medical management and provide high-quality nursing care for both acute clients in

an inpatient setting as well as on an outpatient bases to diabetics within the community. The

philosophy of the clinic includes believing clients have rights related to their care they receive

and nurses have duties they must uphold. The Traverse Community Diabetic Services

organizational goals include providing education, counseling and direct care relating to type 1 or

2 diabetes on an inpatient and outpatient basis. Organizational objectives embrace providing

comprehensive care for diabetes by educating the community about awareness, prevention and

management of diabetes through the use of seminars and screening. Furthermore, an

organizational chart has been constructed and job descriptions were created to include all staff

needed at the facility and advertised in diabetes journals, Traverse City Record Eagle, at

healthcare organizations, and free electronic resources. Lastly, a fiscal budget was proposed

which included staffing, funding/reimbursement, and operating expenses.


Traverse Community Diabetic Services

Organizing oneself into a group to accomplish a task has been a practice that some may

say is as old as time. However, becoming knowledgeable on finding out how an organization

achieves its work, how to function productively within the organization and how to manipulate

organizational processes is essential to the success of a professional nursing practice (Yoder,

2011). Working within a small group an analysis of both the external and internal environments

was made and an agency was created, the Traverse Community Diabetic Services Clinic. This

clinic was designed to best serve the healthcare needs of the residents of Grand Traverse and

surrounding counties. The clinic’s make-up is complete with a mission statement, philosophy,

organizational goals, organizational objectives, organizational chart, job descriptions, job

advertisement, and budget proposal.

Diabetes Mellitus type 2 is a chronic condition which involves elevated blood sugar

levels. According to the 2011 National Diabetes Fact Sheet published by the American Diabetes

Association (ADA), there was a reported 25.8 million children and adults in the United States

living with diabetes (ADA, 2012). In addition, it was reported that 7 million people were

estimated to be undiagnosed and 79 million people are pre-diabetic (ADA, 2012). Diabetes is a

serious disease that carries serious complications. Complications include heart disease, stroke,

high blood pressure, blindness, kidney disease, neuropathy, and amputations. Risk factors for

developing type 2 diabetes include being over the age of 45, having a family history of diabetes,

being overweight, not exercising regularly, having low HDL cholesterol, high triglycerides or

high blood pressure. Women carry an additional risk if they have had a baby weighing 9 pounds

or more at birth or having gestational diabetes during pregnancy. An impaired glucose tolerance

or impaired fasting glucose is also a risk factor (ADA, 2012).


According to the ADA (2012), in 2007 the total costs of diabetes in the United States was

$174 billion, with $116 billion associated for direct medical costs, and $58 billion for indirect

cost which include disability, work loss, and premature mortality. Health care costs associated

with diabetes have rose 32 percent from 2002 to 2007 (MDCH, 2011). Diabetes is the leading

cause of kidney failure, blindness and lower-limb amputation. The Michigan Department of

Community Health estimated economic burden of pre-diabetes and diabetes reached $9 billion in

2007. If diabetes continues to grow at this rate, the economic burden of diagnosed diabetes alone

will double in size by 2034. Programs that decrease the severity of medical complications

associated with diabetes needs to be a priority. Therefore a closer examination of the local

environments response to this epidemic is warranted.

Assessment of External and Internal Environment

External Environment

Michigan’s growth in diabetes cases parallels with national trends. In Michigan, men

have higher diabetes prevalence than females. The older population has a higher prevalence rate

peaking among 65-74 year olds. “It is estimated 701,000 Michigan adults have been diagnosed

with diabetes, and another 364,400 have undiagnosed diabetes. This means over 1 million adults

in Michigan have diabetes” (MDCH, 2011, p. 8). Michigan has consistently been higher than the

nation as a whole in prevalence rates of diabetes. Four counties surrounding Grand Traverse

County; (Leelanau, Benzie, Manistee and Kalkaska) have a diabetes prevalence rate over 10%,

which is higher than the Michigan’s average of 9.2% (MDCH, 2011). Michigan healthcare

coverage is a major concern for all adults. Lack of insurance coverage is more of an immediate

risk to people with diabetes. Michigan had an estimated 1.15 million uninsured residents in 2008,


and the likelihood of being uninsured appears to be higher in the more northern counties

(MDCH, 2011).

According to the U.S. Department of Health & Human Services (2012) overweight is

classified as a body mass index (BMI) of 25-29.9, and obesity is classified as a BMI of 30 or

greater. As stated being overweight is a risk factor for diabetes. The Centers for Disease Control

and Prevention (CDC) reported that Grand Traverse and surrounding counties had an obesity

percent ranging from 28.4-31.1% in 2008 (CDC, 2012). Furthermore, 20.7-25.9% of Grand

Traverse County and surrounding residents were reported in 2008 to be classified as physical

inactive (CDC, 2012). In addition, the U.S. Census Bureau (2010) reported that 45.3% of the

total population for Grand Traverse county was 45 years of age or older in 2010. Lastly a recent

CDC report estimates that one third of the population will have diabetes by 2050 (Abc news,

2010). Due to the elevated rates of obesity, an aging population, and physical inactivity in Grand

Traverse and surrounding counties along with the estimated increase in diabetes in the years to

come Grand Traverse County would benefit from a diabetes clinic.

Internal Environment

Grand Traverse County is centrally located to many surrounding counties including

Wexford, Leelanau, Benzie, Manistee and Kalkaska. Although there is an abundance of primary

care physician’s offices around the area, there are not any clinics that provide services to patients

on an outpatient and inpatient basis. There is one clinic, Munson Diabetes and Nutrition Center,

located at the Munson Community Health Center which offers outpatient services to diabetics.

However the goal of our clinic is to provide care, education and counseling to newly diagnosed

diabetics suffering from either type 1 or type 2 diagnoses. The clinic will be staffed with three


registered nurses, a physician, a midlevel provider, and a registered dietician. The clinic’s staff

will provide outpatient services, as well as services for inpatient newly diabetics. We will see

patients in the hospital on a referral basis from hospital staff. This will allow for the patient to

receive specialized diabetes education before they even leave the hospital. The clinic staff will

schedule the patient for further education at our outpatient clinic upon discharge. We will also be

taking referrals from local primary care offices for patients in need of diabetes education as an

outpatient.

Our Mission Statement

At Traverse Community Diabetic Services our purpose is to provide exceptional diabetes

education, medical management, and provide high-quality nursing care for both acute clients in

an inpatient setting as well as on an outpatient basis to diabetics within the community. We

strive to provide a multidisciplinary approach to the care of the diabetic client and are committed

to assisting our clients in managing a healthy life with diabetes.

Our Philosophy

We believe that clients:

have the right to person centered, non-discriminatory care delivered in an environment of

respect and dignity.

have the right to high-quality nursing care in any setting which provides continuity of

care that may range from an inpatient acute setting to chronic disease management in a

community or home setting.

have the opportunity to function at the highest level possible through the education,

prevention, and treatment of diabetes and diabetes-related illnesses.


We believe that nurses:

have a duty to advocate for the client and put the client's needs and rights first.

have a duty to uphold nursing standards of care in a professional manner.

have a duty to provide evidence-based holistic care to address biophysical, psychological,

social, and cognitive needs in order to promote the health and well-being of clients and

the community as a whole.

The clinic’s founders believe that it is important to provide fair and competent care for all

clients in a person centered atmosphere. It is a nurses’ professional responsibility to provide

evidence-based and comprehensive diabetes education, prevention, and treatment within the

construct of a multidisciplinary team. In addition to the mission and philosophy statements, the

clinic will have organization goals and objectives to both ensure success and client satisfactions.

Organizational Goals

Provide education, counseling and direct care relating to type 1 or 2 diabetes on an

inpatient and outpatient basis.

Be the diabetes education resource for the Traverse area community.

Provide compassionate care to all clients that services are provided to.

All care given is supported by current, evidenced based practice.

Increase awareness of diabetes risk factors, signs, and symptoms to members of the

community.

Care, education, and services will be provided based on the needs of the individual and

the community.

Increase in the quality of life of those living with diabetes.


Organizational Objectives

1. To educate the community about awareness, prevention, and management of diabetes by

providing public education seminars and screening on a monthly basis.

2. To assist clients and families in establishing initial care and education of diabetes both

inpatient and outpatient.

3. To provide scheduled ongoing care of diabetes as recommended by health care provider.

4. To provide care in an interdisciplinary way by communicating with primary health

providers and consider referrals to specialist assessment when indicated.

5. To improve the quality of life for patients living with diabetes as evidenced by less

diabetic complications.

6. To provide comprehensive care for diabetes that aims not only to treat the disease, but to

minimize the impact it has on our clients' lives as evidenced by less hospitalizations.

7. To reduce morbidity and mortality rates by 5% in the community over the next 10 years.

8. To have more than 90% of clients with diabetes have two A1C tests done at least three

months apart to ensure adequate glucose control for our clients.

Organizational Chart

The Traverse Community Diabetic Services clinic will offer services in the least

complicated manner possible. There will be an RN clinical director who will oversee a shared

governance structure. The clinic will be a standalone organization that will partner with local

health care providers and facilities to provide diabetes related health care services. In a flat

organizational structure, the decision making is generally delegated to the professionals doing

the work. Decentralizing allows staff the authority to make decisions with patients that meet

their specific needs (Mancini, 2011). Shared governance gives nursing staff autonomy to govern


their individual practice and be personally accountable. A phase one shared governance

structure has a nurse executive who retains decision making authority, but staff is responsible for

practice issues and determining roles, functions and processes (Mancini, 2011).

Job Descriptions

Traverse Community Diabetic Services will be staffed with registered nurses, one of

which will be the director of clinical services, a physician, nurse practitioner, registered dietician,

and clerical staff.

RN Clinical Director

Education Requirements.

Current registration with the Michigan Board of Nursing as a professional registered

nurse or advance practice registered nurse.

Graduate of an accredited school of nursing with a Master’s degree in Nursing is

preferred.

Certification in the American Heart Association (AHA) Basic Life Support (BLS).

2 years of management experience required.

Certified Diabetes Educator is preferred.

Responsibilities.

RN Clinic Director

Physician Midlevel provider (NP) Registered Nurse Registered Nurse Registered DieticianClerical Support

(referrals, scheduling & finance)


Perform leadership functions of governance and decision-making within the

organization.

Coordinate all planning, organizing, staffing, and directing of financial funds within

the organization.

Collaborate with all staff members and run day-to-day operations.

Maintain a safe and effective patient environment where diabetes management is

viewed as a shared goal within the organization.

Provide staff with the latest evidence based practice interventions to implement to

improve patient care within the organization.

Registered Nurses


Current registration with the Michigan Board of Nursing as a professional registered

nurse.

Graduate of an accredited school of nursing with a Bachelor’s degree in Nursing is

preferred.

Certification in the American Heart Association (AHA) Basic Life Support (BLS).

2 years of clinical experience required.

Responsibilities.

Collaboration of care between physician, nurse practitioner, and dietitian.

Provide professional care to diabetic clients by utilizing the nursing process to

achieve desired outcomes.

Report to and collaborate with RN clinical director.

Develop and maintain client plan of care.


Demonstrate team working skills.

Adheres to the ANA’s Scope and Standards of Practice.

Physicians


M.D. or D.O. with a minimum of 2 years of medical experience.

Responsibilities.

Provide direct and indirect care to inpatient and outpatient diabetic clients.

Collaborate care with nurse practitioner, dietician, and nursing staff.

Report to RN clinical director.

Adhere to the American Medical Association standards of care.

Mid-level Nurse Practitioner


Graduated from an accredited Master’s degree of Nursing program.

Current MI license as a nurse practitioner and prescription privileges required.

2 years of endocrine experience preferred.

Responsibilities.

Provide direct and indirect care to inpatient and outpatient diabetic clients.

Identifies patient needs, skills, and knowledge needed to live with diabetes.

Collaborate with the physician, dietician, and nursing staff.

Report to RN clinical director.

Adhere to the ANA scope and standards of practice.

Registered Dietician



Graduate of an accredited college or university earning a Bachelor’s degree in

Dietetics. Obtaining a postgraduate diploma or Master’s degree in Dietetics is

preferred.

Completed at least 1200 hours of practical, supervised experience through an

accredited program.

Passed the national registration examination to become registered with the

Commission on Dietetic Registration.

Specialize in diabetes management or Certified Diabetes Educator is preferred.

2 years of experience required.

Responsibilities.

Develop specialized diets for diabetic patients.

Teach patients and their families about the importance of nutrition, diet, and food

selection and how this affects their diabetes management.

Evaluate how patients respond to their diets and make adjustments accordingly.

Teach classes about diet, nutrition and food related to diabetes.

Collaborate all patient care with the physician, nurse practitioner, and nursing staff.

Report to the RN Clinical Director.

Adhere to the Registered Dietitian’s Standards of Practice.

Clerical Support


Minimum of an Associate’s degree with a focus in business administration or finance

required.

Past medical experience preferred.


Past billing experience preferred.

Responsibilities.

Operation of office front desk.

Schedules client appointments.

Assists clinical staff with daily operations of the office.

Handles the billing and finances for the clinic, as well as, collaborates with the RN

clinical director for budget purposes.

Demonstrates excellent customer service and maintains a positive attitude.

Job Advertisement

Traverse CommunityDiabetic Services

321 Cherry Blvd, Traverse City MI 49684(231)944-4444 www.TCdiabeticservices.com

CLINIC MISSION STATEMENTTo provide exceptional diabetes education, management

and nursing care for inpatient and outpatient diabetics

using a multidisciplinary approach.

RN RESPONSIBILITIESProvide excellence in professional care to clients using

nursing process & creating/maintaining plan of care

Demonstrate proficient teamwork & collaborative skills.

RN JOB REQUIREMENTSCurrent RN licensure with Michigan Board of Nursing

American Heart Association BLS certification

2 years clinical experience required (BSN preferred)

NowHiring

RegisteredNurses

Download application

from website

Equal OpportunityEmployer

Competitive Salary

Excellent Benefits


Diabetes Journal

The American Diabetes Association (ADA) publishes the Diabetes Journal on a monthly

basis. Traverse Community Diabetic Services plans to run an advertisement for one month. The

advertisement would be in full color, and would be a quarter of a page. The price for this is

$4370. By running this advertisement in the Diabetes Journal, our hope is to not only attract

healthcare professionals who have a passion for diabetes, but also, will make our services known

to those in need of diabetic care.

Traverse City Record Eagle

This local newspaper reaches all of Northern Michigan which provides the clinic an

opportunity to reach large volumes of people. Traverse Community Diabetic Services will place

an advertisement in the paper on three separate days for the duration of one week. The

advertisement will be 3.58” x 8”. The advertisement will first appear in the Sunday edition at the

price of $400, again in the Wednesday edition for $200, then again on Friday which will be free

of charge.

Hospital/Healthcare Organizations

Flyers and brochures for the clinic will be made to advertise and will be distributed

among the healthcare community. Munson Medical Center has multiple areas around the

hospital in which flyers may be placed. Nursing homes, doctor’s offices, and the Grand

Traverse Health Department will also receive flyers to place on their bulletin boards.

Free Electronic Resources

Traverse Community Diabetic Services will utilize free internet classifieds for further

exposure to the community. We will post under jobs on the northern Michigan section on

craigslist and on E Bay classifieds. We will also use these two free sites for announcing our


services to diabetics in the community. Under the community section we will post an

announcement of the new clinic and a highlight of the services offered. The clinic will also

create a Facebook page. Facebook is an easy way for the clinic to gain exposure and will allow

community members to easy view updates from the clinic.

Budget Proposal

In order to properly run Traverse Community Diabetic Services, a budget has to be made.

Factors that affect this budget include but are not limited to, operating costs, supplies, equipment,

salaries, benefits, and advertising. The fiscal year for the clinic will begin on January 1st and end

on December 31st.

Staffing

The hours of operation for Traverse Community Diabetic Services will be Monday

through Friday from 8:00 am - 4:00 pm. The clinic will be closed for the following holidays:

New Year’s Day, Memorial Day, Independence Day, Labor Day, and Christmas. There will be

two full time registered nurses Monday through Friday. There will be a full time clerical staff

employee present Monday through Friday. The doctor and nurse practitioner will be available

throughout the week, as well as the registered dietician. The salaries for these positions are as

follows:

Registered Nurse Manager- 60,000- 70,000

Physician- 145,000-155,000

Registered Nurse- 40,000-50,000

Nurse Practitioner- 70,000-80,000

Registered Dietitian- 40,000-50,000

Clerical Staff- 20,000-30,000


The clinic will provide benefits to the full time employees. This will include health, vision, and

dental plans through Priority Health. There will be PTO time for each 12 hours worked each

employee will accrue one hour of PTO time which will be a combination of personal, sick, and

vacation days. There will not be any on call pay available.

Funding/Reimbursement

To obtain funding for this clinic, medical grants, private donations, and bank loans will

be utilized. Through the State of Michigan and the American Association of Diabetes Education,

there are an abundance of grants available to apply for. The community in which the clinic is

located has an array of members that are known for making large contributions to medical

facilities. Any other funds that will be necessary for the initial start-up costs and other expenses

will be from bank loans.

The care provided to clients will be reimbursed through insurance companies. Traverse

Community Diabetic Services will accept Medicare Part A (inpatient) and B (outpatient),

Priority Health, and Blue Cross Blue Shield. At this time Medicaid will not be accepted.

Operating Expenses

The yearly costs to operate Traverse Community Diabetic Services will have several

expenses. Electric will be through Traverse City Light and Power, gas/heat through DTE Energy

will run approximately $13,000 annually. Water through the township is roughly $3360

annually. General waste disposal with Waste Management is around $1200, medical waste

through Steri-Cycle $3400. The phone system, with 5 lines through AT&T will run around

$16,000 annually. Supplies will be ordered through medical supply wholesalers. We will be

purchasing the majority of our supplies in bulk quantities which will cut down on the cost. The

gross estimate for the medical supplies for the year is $ 16, 400. The gross estimate for office


supplies is around $19,600. Postage costs for the office are estimated out around $2,000

annually. Advertisement costs for the clinic annually will be around $17,000. Insurances for the

clinic itself, workman’s compensation, and malpractice will all also be estimated around $20,000

annually.

Conclusion

Traverse Community Diabetic Services was created due to the identified need in our

country and community. With over 25 million adults and children living with diabetes in the

United States we see an alarming need for more education clinics nationwide (ADA, 2012). We

are committed to help better the lives of people in our community who are affected by diabetes.

The identified plan for staffing, advertisement, goals, and budget will guide us through the

process of building our clinic. With the support from our state and community we can make this

clinic a reality and begin changing lives.


References

Abc News (2010). Disturbing diabetes forecast linked to obesity. Retrieved from

http://abcnews.go.com/Health/Diabetes/cdc-predicts-dramatic-increase-diabetes/story?

id=11946076.

American Diabetes Association (2012). Diabetes statistics. Retrieved from

http://www.diabetes.org/diabetes-basics/diabetes-statistics/.

Centers for Disease Control and Prevention (2012). County level estimates of obesity-state maps.

Retrieved from http://apps.nccd.cdc.gov/DDT_STRS2/CountyPrevalenceData.aspx?

mode=OBS.

Centers for Disease Control and Prevention (2012). County level estimates of leisure-time

physical inactivity-state map. Retrieved from

http://apps.nccd.cdc.gov/DDT_STRS2/CountyPrevalenceData.aspx?mode=OBS.

Mancini, M. E. (2011). Understanding and designing organizational structures. In P. Yoder-

Wise, Leading and managing in nursing (5th ed., pp. 137-156). St. Louis, MO: Elsevier

Mosby.

Michigan Department of Community Health. (2011). The impact of diabetes in Michigan.

Retrieved January 25, 2012 from

http://www.michigan.gov/documents/mdch/2011_Burden_Report_365233_7.pdf

U.S. Census Bureau (2010). Profile of general population and house characteristics: 2010.

Retrieved from

http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk.

U.S. Department of Health & Human Services (2012). Calculate your body mass index.

Retrieved from http://www.nhlbisupport.com/bmi/.


Yoder-Wise, P.S. (2001). Leading and managing in nursing (5th ed.). St. Louis, MO: Elsevier

Mosby.

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