The current climate of managed care has sparked efforts to reduce costs in patient care. In many cases, this has resulted in more efficient methods of patient management: chronic disease management in an outpatient setting appears to be one such success story. For critical care nurses interested in working beyond the boundaries of a traditional ICU, chronic disease management clinics represent an alternative environment in which they may apply their skills. Nancy Brass-Mynderse, RN, MSN, CCRN, a clinical nurse specialist (CNS) with 18 years of experience in critical care, was instrumental in development of the Scripps Health Chronic Disease Clinic at Green Hospital of Scripps Clinic, San Diego, Calif. Brass-Mynderse currently supervises the operation of the clinic, along with Omana Kaliangara, RN, MSN, CFNP, a nurse practitioner. Brass-Mynderse received her bachelor's degree from the University of Arizona, Tucson, Ariz, and her master's degree from San Diego State University. She recently obtained her family nurse practitioner certificate from California State University, Dominguez Hills, Calif. Kaliangara received her bachelor's degree from San Jose State University, San Jose, Calif, and her nurse practitioner certificate from the University of California, San Francisco, Calif. After working in family medicine and a diabetic clinic, Kaliangara developed an interest in the management of chronic diseases. In an interview with CRITICAL CARE NURSE in September, Brass-Mynderse and Kaliangara took time to discuss the development and operation of the clinic, and to recount some of their success stories.

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