This exploratory research study used a descriptive, self-report survey design. There is and will be an urgent need for nurses to understand and to grow their practice if they are to adequately respond to these significant social changes. That is, structures are constituted as nurse demographics, education, settings, and skill mix. More information about advertising is also available on our Sponsors page. From Nurse.com: Nurse Salary Research Report. Objective measures of activities and outcomes were not part of the study. The nurses were experienced, with a mean of 20.68 years (SD = 11.3) of clinical practice as an RN and a mean of 9.45 years (SD = 8.54) of practice in ambulatory care. Seventeen ambulatory care practice nurse leaders in the health care organization validated the survey content. The Patient Protection and Affordable Care Act of 2010. Movement in health care to chronic care models and the team approach requires that all team members practice collaboratively. Descriptive statistics, including percentages, frequencies, means, and standard deviations (SDs), were used to generate the findings. Assessment and triage activities reflect the nursing process,15,29 with message management aligning with telephone communication.15 The evidence from this exploratory study supports the relevance of RN assessment and surveillance to daily practice. Three Professors Reveal How Nursing Schools are Adapting to COVID-19. The survey supports what ambulatory care RNs say they are doing: daily, diverse, and complex patient care activities. Haas SA, Hackbarth DP, Kavanagh JA, Vlasses F. Dimensions of the staff nurse role in ambulatory care: Part IIComparison of role dimensions in four ambulatory settings. Examples include 1) body mass index improvement, 2) normalization of blood glucose levels, 3) decrease in medication for the patient, and 4) appropriate care products for the patient. Survey respondents were ambulatory care staff RNs from various primary and specialty care clinics (n = 187) in an integrated health care organization in Southern California. Mastal M, Levine J. Many nurses reported some involvement with message management; however, the scope of involvement varied widely on a daily basis (Table 3). Analogous to activities, a few outcomes were marked high as infrequent and high percentages as zero/not applicable. Nurses perceived that they influenced multiple relevant patient outcomes on a daily basis. Staples P, Earle W. The role and scope of practice of nurses working in Canadian heart failure clinics. FOIA Omery A. will also be available for a limited time. Nurses self-reported effect on the outcome of normalizing general patient laboratory values reflects many population-specific targets for ambulatory care performance measures.1,2,30 Although the findings from this study align with previous literature that articulates a multitude of domains that is the current state of ambulatory care nursing practice and its varied dimensions, it does not reflect specific regulated outcome indicators such as Healthcare Effectiveness Data and Information Set (HEDIS) measures.34 Further research on outcomes for ambulatory care nurses should reflect those measures in primary and specialty care that are established as critical or even regulatory. Eighteen separate outcomes were listed on the survey. Nursing intervention and evaluation completes the process for RN practice. 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We welcome you to submit your article to ViewPoint. E-mail: Senior Director for Clinical Practice for Patient Care Services for Kaiser Permanente Southern California in Pasadena. Patients and families who often are struggling in the complex ambulatory care environment require the presence of and care provided by these highly educated clinical professionals. If you've been thinking about writing, this is a wonderful motivator. For each activity, the percentage of nurses who reported completion more than 15 times, in addition to the percentage who reported the same activity less than 5 times a shift, are displayed across the row. AAACN members enjoy reduced pricing on all of our educational offerings. Dimensions of the staff nurse role in ambulatory care: Part IVDeveloping nursing intensity measures, standards, clinical ladders, and QI programs.

and transmitted securely. Four tacks to choose from: CCTM; Clinical; Leadership; Telehealth. Most respondents reported a range vs a single number of managed messages per shift. The following activities ranked among those at the bottom of Table 4: 1) assist while a clinician completes treatments or diagnostic procedures, 2) teaching patients and/or family daily self-monitoring techniques, or 3) arranging for appropriate at-home equipment. The value of registered nurses in ambulatory care settings: a survey. Swan BA, Conway-Phillips R, Griffin KF. Baghi H, Panniers TL, Smolenski MC. Research findings of interest to the ambulatory care community. Ambulatory care is a growing field of nursing practice. If nursing is not seen as having an impact on those measures, the members of the discipline will not be seen as important to the outcomes achieved in their practice setting. We spoke with three nursing faculty from different states to find out how the pandemic has affected students returning to nursing education this fall Two ways to attend: In-person or Virtual Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. ViewPoint is the official publication of the American Academy of Ambulatory Care Nursing (AAACN). In the Nursing Role Effectiveness Model, the nurse is considered a structure. In the absence of a sufficient sample size to achieve power, a sample of approximately 188 was deemed sufficient for reporting the findings because it would yield results with an acceptable 7% margin of error at a confidence level of 95%. Thirty specific activities were part of the survey. Results regarding message management align with the literature related to the telephone advice nurse4,36,37 (Tables 3 and and4).4). It is a peer-reviewed, bimonthly resource for nursing professionals. The activities that most ambulatory care nurses reported as occurring most frequently were related to assessment. The nurses suggested future surveys that examine activities every week or per month. Future research studies could reveal best practices related to message management, as well as activities and outcomes unique to specialty care populations. The range was 0 to 39 per shift for nurses in specialty care. Characteristics of ambulatory care staff registered nurse respondents (N = 187). Another opportunity within the scope of practice of the ambulatory care staff RN is influencing patient self-care ability with both highly infrequent, yet low percentage of zero/not applicable scores. The https:// ensures that you are connecting to the Establishing a definition for a nurse-led clinic: structure, process, and outcome. This study sought to describe the perceived impact of components of the staff RN role on specific activities and outcomes, as guided by the structures, processes, and outcomes of the Nursing Role Effectiveness Model. The need for additional research is illustrated by a recent call to survey RNs in the ambulatory setting using the framework of performance measures.6 The purpose of this exploratory study was to describe the perceived impact of various components of the staff RN role on specific outcomes at one integrated health care system. Schroeder CA, Trehearne B, Ward D. Expanded role of nursing in ambulatory managed care. The site is secure.

Learn more about ambulatory care nursing, care coordination and transition management, telehealth, and the latest news through AAACNs publications and resources. The basis for this model is the Donabedian structure-process-outcome model of high-quality care.26 This model suggests that to achieve quality outcomes, efficient processes must be completed within effective structures leading to the desired outcomes. Accessibility

Institutional subscriptions are available in the Online Store. A key comment was that respondents found it difficult to quantify activities and outcomes per shift. AAACN encourages ambulatory care nurses to take the extra step in your career and get certified through the American Nurses Credentialing Center (ANCC). Many respondents took the opportunity to articulate any additional outcomes and activities related to their role. The sample was composed of 10% male respondents, which is slightly lower than a 2008 California survey reporting 14% of all RNs as male.35 Nevertheless, the visibility of male nurses in the ambulatory care setting is encouraging. Their willingness to voice their perceptions made this research study and subsequent article possible. Their educational preparation was primarily at the associate degree level (40.6%; n = 76). Demonstrating the value of the RN in ambulatory care. The top 5 patient outcomes the nurses felt they influenced at least 15 times per shift were 1) patient satisfaction, 2) normal laboratory values, 3) prevention of complications, 4) correct level of medical treatment, and 5) decreased anxiety levels (Table 5). Youll find the following resources will help you and answer questions you may have. Wong FK, Chung LC. The A new initiative or practice at your facility. The future of nursing: leading change, advancing health. Acute emergency response activities for stabilization were more common than expected. The knowledge gained from this study has the potential to enhance the quality of ambulatory care for patients in the community setting. Process questions captured the perceived frequency that RNs were involved in assessment, intervention, teaching, evaluation, care coordination, and execution of medical orders. Examples included assisting patients during syncopal episodes and patient assessment/monitoring while waiting for paramedic transport to an Emergency Department. For outcomes, this may reflect irrelevance to the role or that the outcome is considered too long term to achieve in relation to a worked shift. Learn more Part II: Impact on outcomes of costs, quality, provider and patient satisfaction. One reported activity identified as consultation could be inferred as falling under the American Academy of Ambulatory Care Nursing 2010 standards of collegiality and collaboration. Reported frequency of activities of ambulatory care staff registered nurses. Meade CM, Bursell AL, Ketelsen L. Effects of nursing rounds on patients call light use, satisfaction, and safety. about navigating our updated article layout. Results appear to reflect potential opportunities for consideration that are within the ambulatory care staff RNs scope of practice. Processes in the model are the activities of the nurses role, as illustrated by nurse-initiated independent processes such as self-care facilitation, exercise enhancement, and nutritional support. Mullen BA, Kelley PA. Diabetes nurse case management: an effective tool. government site. Code blue situations and 911 calls were repeatedly discussed. The AAACN Online Library houses a vast clearinghouse of ambulatory care nursing resources. The authors also thank the nurses who participated in the survey. The Professional Practice of Registered Nurses, www.qualityfo-rum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=17788, www.qualityfo-rum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=17789, www.bls.gov/ooh/Healthcare/Registered-nurses.htm#tab-6, http://dx.doi.org/10.1097/NNA.0b013e3181aeb4cf, http://dx.doi.org/10.1111/j.1745-7599.2006.00095.x, http://dx.doi.org/10.1016/j.apnu.2007.05.004, http://dx.doi.org/10.1016/j.hrtlng.2004.01.001, http://dx.doi.org/10.1111/j.1479-6988.2007.00070.x, http://dx.doi.org/10.2337/dia-care.26.4.1058, http://dx.doi.org/10.1891/154041507780851932, http://dx.doi.org/10.1111/j.1365-2648.2006.03730.x, http://dx.doi.org/10.1046/j.1365-2648.2002.02143.x, http://dx.doi.org/10.1097/NUR.0b013e3181cf5520, http://dx.doi.org/10.1891/106137407780851787, www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=49506, www.aaacn.org/sites/default/files/Ambulatory_TCO.pdf, www.ncqa.org/Portals/0/HEDISQM/HEDIS2013/List_of_HEDIS_2013_Measures_7.2.12.pdf, www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20CaliforniaNursesFactsFigures2010.pdf, http://dx.doi.org/10.1097/00005110-200306000-00009, http://dx.doi.org/10.1097/00005110-200304000-00006, Years as staff RN in ambulatory care (n = 185), Primary care (includes Family Medicine, Adult Internal Medicine), Patient encounters: Yes, I see patients in person, Walk-in patients: number of walk-in patients I assess for care, Assessing the patients chief complaint and subjective history, Conducting nurse advice during message management, Triaging and arranging access to appropriate level of care on the basis of assessment, Developing immediate plan of nursing care, Initiating and managing treatments (as orders or preset standardized procedures), Establishing with the patient the long-term outcome goal, Teaching patients and/or family health nutrition, Consultation with clinicians on plan of care, Teaching patients and/or family physical activity guidelines, Teaching the patient and/or family medication administration, Teaching patients and/or family safety measures, Evaluation of patient readiness for release/discharge from the ambulatory setting, Completing/reviewing discharge instructions with the patient or family, Initiating and managing medications (as orders or preset standardized procedures), Coordinating/pending radiograph (x-ray) or diagnostic procedure, Teaching the patient and/or family administration of treatments/procedures for self-care, Assist while a clinician completes treatments or diagnostic procedures, Teaching the patient and/or family operation of equipment or products, Teaching patients and/or family daily self-monitoring techniques (eg, blood glucose, daily weigh-in), Coordinating patient care with other departments (eg, Pharmacy or Social Services), Arranging for appropriate at-home equipment, Patient receiving the correct level of medical treatment in relation to presenting need, Improved patient and/or family knowledge of disease process, Prevention of admission to acute care unit, Increased family/significant others ability to participate in the patients care, Decreased excessive wait time for the patient, Normalization of blood pressure measurements, Decreased number of office visits for the patient, Decrease in needed medication for the patient, Appropriate care products for the patient. Linking nursing workload and performance indicators in ambulatory care. If one circles back to the activities-related findings, in which it was identified that most of these nurses spend the majority of their time in assessment activities, one disconcerting conclusion might be that, indeed, these nurses are not being used to their fullest capacity. The most frequently reported activities included patient assessment, nurse advice during message management, and completion of patient triage. Before E-mail: Director of Regional Nursing Education and Research for the Southern California Permanente Medical Group in Pasadena. For these activities, there was also a high rate of zero/not applicable responses. COVID-19 has changed nursing schools for the foreseeable future. Description of practice as an ambulatory care nurse: psychometric properties of a practice-analysis survey. If the tradition in nursing practice in ambulatory care has been to hand off to another clinician such as an advanced practice nurse, a physician assistant, or a physician, how are nurse and operational leaders going to assist staff RNs in practicing to the full scope of regulatory activities? Activities of interest for further examination are those in the middle of activity rankings (Table 4). The survey results support the premise that the respondents have an astute familiarity with their nursing practice that is acquired over time.