Professional ambulatory care nursing is a complex, multifaceted specialty that encompasses independent and collaborative practice.
Modern professional ambulatory care nursing is a unique domain of specialty nursing practice that focuses on health care for individuals, families, groups, communities, and populations. Ambulatory care nurses practice in settings distinctive from other nurses.
They practice in primary and specialty care outpatient venues, non-acute surgical and diagnostic outpatient settings in the community, and during telehealth encounters that occur across distances in the virtual environment.
Historically, it was the patient who initiated contact with the ambulatory health care setting. Today, contact is initiated either by the patient or ambulatory care nurse to ensure optimal wellness or for educational purposes. More recently, a unique nursing role has been defined as a result of the Patient Protection and Affordable Care Act of 2010.
The definition of ambulatory care nursing can be found in the Core Curriculum for Ambulatory Care Nursing.
This new role, Care Coordination and Transition Management (Haas, Swan, & Haynes, 2014), has formalized the role of the nurse who collaborates and partners with the health consumer and other health professionals to ensure the health consumer accesses and receives appropriate care across health care continuum providers, agencies, and businesses.
Ambulatory care nursing is typified by registered nurses (RNs) caring for high volumes of patients in short periods of time, often dealing with issues in each encounter that can be unpredictable. These encounters encompass both collaborative and RN independent activities. In partnership and collaboration with other health care professionals, ambulatory care RNs address patients’ wellness, acute illnesses, chronic diseases, disabilities, and end-of-life needs.
In the professional domain of nursing, RNs are responsible for patient advocacy, application of evidence-based nursing knowledge, use of the nursing process during encounters, coordination of nursing and other health services, provision of health educational services, and continuity of care for patients as they transition across different types and levels of health care continuum services.
Haas, S.A., Swan, B.A. & Haynes, T.S. (2014). Care coordination and transition management core curriculum. Pitman, NJ: American Academy of Ambulatory Care Nursing.
The Defining Characteristics of Ambulatory Care Nursing
Defining characteristics: Differentiate ambulatory care nursing as a specialty distinct from other specialties and describe major attributes (AAACN, 2017).
- Ambulatory nursing care requires critical reasoning and astute clinical judgment to expedite appropriate care and treatment, especially given the patient may present with complex problems or potentially life-threatening conditions.
- Ambulatory care RNs provide quality care across the life span to individuals, families, caregivers, groups, populations, and communities.
- Ambulatory care nursing occurs across the continuum of care in a variety of settings, which include but are not limited to:
- Hospital-based outpatient clinics/centers.
- Solo or group medical practices.
- Ambulatory surgery and diagnostic procedure centers.
- Telehealth service environments.
- University and community hospital clinics.
- Military and Veterans Administration settings.
- Nurse-managed clinics.
- Managed care organizations.
- Colleges and educational institutions.
- Freestanding community facilities.
- Care coordination organizations.
- Patients' homes.
- Ambulatory care RNs interact with patients during face-to-face encounters or through a variety of telecommunication strategies in the virtual environment, often establishing long-term relationships.
- Telehealth nursing is an integral component of professional ambulatory care nursing that utilizes a variety of telecommunications technologies during encounters to assess, triage, provide nursing consultation, perform follow up and care coordination.
- Ambulatory care RNs practicing in telehealth environments adhere to the Scope and Standards of Practice for Professional Telehealth Nursing (AAACN, 2018).
- During each encounter, the ambulatory care RN focuses on patient safety and quality of nursing care by applying appropriate nursing interventions, such as identifying and clarifying patient needs, performing procedures, conducting health education, promoting patient advocacy, coordinating nursing and other health services, assisting patient to navigate health care system, and evaluating patient outcomes.
- Nurse-patient encounters in clinical settings can occur once or as a series of occurrences, are usually less than 24 hours in length, and occur in single or group settings.
- Ambulatory care RNs, acting as partners, advocates, and advisors, assist and support patients/families in the optimal management of their health care, respecting their culture and values, individual needs, health goals, and treatment preferences.
- Ambulatory care RNs facilitate continuity of care using the nursing process, interprofessional collaboration, and coordination of and access to appropriate health care services and community resources across the care continuum.
- Ambulatory care RNs are knowledgeable about and provide leadership in the clinical and managerial operations of the organization.
- Ambulatory care RNs design, administer, and evaluate nursing services within the organization in accord with relevant federal requirements, state laws and nurse practice acts, regulatory standards, and institutional policies and procedures.
- Ambulatory care RNs provide operational accountability for and coordination of nursing services, including the appropriate skill mix and delegation of roles and responsibilities for licensed and unlicensed nursing personnel.
- Ambulatory care RNs apply the provisions of the ANA Code of Ethics for Nurses (2015) to their own professional practice.
- Ambulatory care RNs pursue lifelong learning which updates and expands their clinical, organizational, and professional knowledge, skills, and abilities in professional practice.
- Ambulatory care RNs functioning in care coordination and transition management roles and settings adhere to the AAACN Scope and Standards of Practice for Registered Nurses in Care Coordination and Transition Management (AAACN, 2016). See Chapter 14, Care Coordination and Transition Management.
- American Academy of Ambulatory Care Nursing (AAACN). (2016). Scope and standards of practice for registered nurses in care coordination and transition management. Pitman, NJ: Author.
- American Academy of Ambulatory Care Nursing (AAACN). (2017). Scope and standards of practice for professional ambulatory care nursing. Pitman, NJ: Author.
- American Academy of Ambulatory Care Nursing (AAACN). (2018). Scope and standards of practice for professional telehealth nursing (6th ed.). Pitman, NJ: Author.
- American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author