Models of care have long been transitioning from acute to ambulatory settings. As a result, nurses’ roles in ambulatory care have drastically changed to accommodate not only more patients but also those who with more complex needs.
E. Mary Johnson, BSN, RN-BC, NE-BC, a speaker for Nurse.com’s Ambulatory Care Nursing Certification Review, remembers when cataract patients would have their surgeries in hospitals and remain inpatients for several days with their heads immobilized by sandbags. Today, cataract and many other surgeries that used to require days in the hospital are now performed in the ambulatory care setting.
“Ambulatory nursing is really about collaboration and coordination,” said Johnson, a patient navigator, coach, consultant and nurse leader for more than 35 years.
Nurses are pivotal in ambulatory care delivery. They understand plans of care and how to communicate those to patients and families, and they know what to do and who to call if something goes wrong.
Care will continue to shift from traditional acute care to ambulatory settings, and the demand for ambulatory care nurses will increase exponentially, according to Susan Paschke, MSN, BA, RN-BC, NEA-BC, a nurse leader, administrator and quality management specialist with 40 years of experience in a variety of healthcare settings.
“Coordination of care and management of the transitions between levels of care are natural roles for ambulatory care nurses,” said Paschke, also a speaker for the Nurse.com Ambulatory Care Nursing Certification Review course.
“Virtual visits and telephonic care also are in the realm of the ambulatory care nurse,” and these duties have ramped up during the pandemic, she said.
Ambulatory care settings include traditional medical clinics, urgent care centers and outpatient surgery centers. Ambulatory care nurses work in infusion clinics, outpatient oncology units, retail centers that have onsite clinics, schools and even in long-term care, where nurse practitioners might do rounding, according to Johnson.
Pharmaceutical companies hire these nurses to educate, coach, monitor and triage patients that use specialty drugs and other treatments for rare diseases. These nurses also deliver care in people’s homes. For instance, these nurses teach parents and children how to use at insulin pumps, cardiac monitors and other equipment in the home, said Johnson.
Ambulatory nursing’s distinguishing factor
The transition from acute care to ambulatory care might not be seamless for many nurses. That’s because telephone triage is a key distinguishing characteristic in ambulatory care. Nurses in acute care usually have their patients in front of them as they’re getting data, educating and more.
“Nurses in critical care have a lot of experience managing crises,” Johnson said. “They have a lot of equipment to help them understand what’s going on.”
Nurses doing telephone triage don’t see patients. They use standard protocols, as well as nursing judgement to effectively do patient interviews, collect data and listen to what patients are saying and what their needs are. It’s a skill, according to Johnson.
Effective telehealth can keep patients out of the clinic and safe, as well as respond in a timely way to patients whose symptoms are worsening.
Why get certified?
Certification is, in general, important for nurses in any given specialty, according to Johnson. “Certification is sort of the gift your give yourself and your institution,” she said.
Research has shown nurses who are certified are more competent and confident in what they do.
“When I hired nurses, if I had nurses that were equal in education, skill sets and experience, but one was certified and one was not, I would always hire the certified nurse because I know that nurse has invested in [her or his] career,” Johnson said.
Like in other specialties, nurses have to work 2,000 hours in an ambulatory care setting before sitting for the exam to become certified by the American Academy of Ambulatory Care Nursing.
Certification helps nurses keep up with the constantly changing demands, evidence and complexity.
“Seventy-five percent of all visits in ambulatory care are for chronicity of illness,” Johnson said.
Today’s patients are increasingly using technology to help them and their providers manage chronic healthcare conditions. That means there will be more back-and-forth communications with ambulatory care nurses and doctors as they collect, review, educate and act on the data.
A big issue in ambulatory care
The Nurse Licensure Compact greatly impacts ambulatory care. Nurses in non-NLC states can’t practice across state lines to use telephone triage for their patients if those patients are in different states when they call. That limits the care nurses can provide.
But that issue seems to be easing as more states have become NLC states or have legislation pending during the COVID-19 pandemic. There were 34 NCL member states as of April, with pending legislation in several others, according to the National Council of State Boards of Nursing.
“The one thing that is probably going to change with this crisis is that every state is going to pass compact licensure,” Johnson said. “And it needs to change because our world is mobile. This is an issue that I really support. That way nurses could triage across state lines.”
Johnson described ambulatory care as the “richest” nursing practice in the U.S. today. “You see patients from birth to death,” Johnson said. “The ability to support, coach families and patients about what they need, I think it’s a gift.”