REGISTERED NURSE IN AMBULATORY CARE

Scope of Practice

AMBULATORY CARE REGISTERED NURSE
The registered nurse in ambulatory care uses “evidence based information across a variety of outpatient health care settings to achieve and ensure patient safety and quality of care while improving patient outcomes.” They “promote optimal wellness, participate in the management of acute illness, assist the patient to manage the effects of chronic disease and disability, and provide support in end-of-life care. The ambulatory care registered nurse is accountable for the provision of nursing care in accordance with relevant federal requirements, state laws and nurse practice acts, regulatory standards, the standards of professional ambulatory care nursing practice, other relevant professional standards, and organizational policies.” (AAACN 2011)
EDUCATION, TRAINING & EXPERIENCE

Graduate of accredited school of nursing, bachelor's degree preferred. Experience in telephone triage preferred.

Currently licensed as an RN in the state of Georgia. Maintainscurrent CPR, BLS.

PRACTICE SITE REQUIREMENTS

Competencies are verified at the time of employment and reviewed regularly.

CORE NURSING BEHAVIORS
  1. Assess clinical and psychosocial patient needs across the lifespan to individuals, families, caregivers, groups, populations, and communities.
  2. Establish patient goals and track progress.
  3. Provide patient and family centered, empirically outcome focused care.
  4. Educate and engage patients and their families.
  5. Develop and monitor key components of the certified electronic health record to streamline nursing professional practice documentation and outcomes attainment.
  6. Coordinate care with inter-professional care givers.
  7. Facilitate safe patient transitions to the next care setting.
  8. Assess and incorporate new technologies and evidence based practice.
  9. Create a culture of team work to enhance efficiency and effectiveness of care.
  10. Practice stewardship of resources to reflect systems thinking regarding value based care.

CORE NURSING CHARACTERISTICS

These are the defining characteristics of the ambulatory care nurse as listed in the American Academy of Ambulatory Care Nursing definition of the professional ambulatory care nursing. (AACN 2011)

  1. Requires critical reasoning and astute clinical judgment in order to expedite appropriate care and treatment
  2. Provide care across the life span to individuals, families, caregivers, groups, populations, and communities.
  3. Practice across a continuum of care in various settings including clinics, patient homes, medical practices, surgical and diagnostic centers, telehealth environments, managed care and care coordination environments.
  4. Interact with patients during face-to-face encounter or through a variety of telecommunication strategies, often establishing long-term relationships
  5. Utilize a variety of telecommunication’s technology in encounters to assess, triage, consult and perform follow up and surveillance of patient status and outcomes
  6. During each encounter focuses on patient safety and the quality of nursing care by applying appropriate nursing interventions such as:
  7. Identifying and clarifying patient needs
  8. Performing procedures
  9. Conducting health education
  10. Promoting patient advocacy
  11. Coordinating nursing and other health services
  12. Assisting the patient to navigate the health care system
  13. Evaluating patient outcomes
  14. Nurse – patient encounters can be a single or series of occurrences usually less than 24 hours length at any one time in a single or group setting.
  15. Assists and supports patients and families to optimally manage their health care, respecting their culture and values, individual needs, health goals, and treatment preferences
  16. Facilitate continuity of care using the nursing process, multidisciplinary collaboration, and coordination of appropriate health care services and community resources across the care continuum
  17. Knowledgeable about and provide leadership in the clinical and managerial operations of the organization.
  18. 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.
  19. 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
  20. Apply the provisions of the American Nurses Association Code of Ethics for Nurses
  21. Pursue lifelong learning that updates and expands their clinical, organizational, and professional roles and responsibilities.

STANDARDS OF PRACTICE

Clinical Practice

  1. Assessment: Systematically collect and analyze focused data relating to the health needs and concerns of a patient, group or population using physiological, psycho-socio-cultural, spiritual, economic, age, and lifestyle information as well as the patient’s response to the problem.
  2. Nursing Diagnosis: Develop a nursing statement that represents the nurse’s clinical judgment about the patient’s response to actual or potential health conditions or needs.
  3. Identification of expected outcomes/goals: Identifies, using input from the patient/family, other health care professionals, and current scientific evidence, the expected outcomes of an individual plan of therapies and/or treatments.
  4. Planning: Outlines a set of written statements that set measurable and achievable short and long-term goals to meet expected outcomes.
  5. Implementation: Provides nursing care services to meet the patient’s needs and goals and documents all activities which include coordination of care within the practice setting and across health care settings, employ strategies to promote individual and community wellness.
  6. Evaluation: Continuously appraises the patient’s status and the effectiveness of the care received. The care plan and interventions are revised as appropriate. (AAACN 2010)

Professional Performance

  1. Performance Improvement: Enhance the quality and effectiveness of clinical practice, the organizational system, and professional nursing practice.
  2. Education: Attain knowledge and competency that reflect current ambulatory care nursing practice.
  3. Professional Practice Evaluation: Evaluate own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, regulations, and organizational position descriptions.
  4. Collegiality: Positively interact with and contribute to the professional development of peers and colleagues.
  5. Collaboration: Collaborate with patients, family members, caregivers, and other health care professionals in the conduct of ambulatory care nursing practice.
  6. Ethics: Apply the principles of professional codes of ethics that ensure individual rights in all areas of practice.
  7. Research: Support and facilitate the utilization of research as an evidence base for professional ambulatory care nursing practice
  8. Environment: Actively engage in organizational initiatives that create and maintain an internal environment that is safe, hazard-free, ergonomically correct, confidential, and comfortable for patients, visitors, and staff.
  9. Resource Utilization: Consider factors related to effectiveness, cost, and impact on practice and the organization in the planning and delivery of nursing and health care services in outpatient settings.
  10. Leadership: Demonstrate leadership behaviors in practice settings, across the profession, and in the community. (AAACN 2010)

References

Advisory Board Carol Boston Fleischer 2013 Final Draft

Defining Professional Nursing Practice: Maximizing Role Performance

Core Nursing Behaviors (based on 8 from Advisory Board, 2 added by Leaders of EHC)

American Academy of Ambulatory Care Nursing: Definition of Professional Ambulatory Care Nursing. March 8, 2011.

American Academy of Ambulatory Care Nursing (2012). Perspectives in Ambulatory Care: American Academy of Ambulatory Care Nursing Position Statement: The Role of the Registered Nurse in Ambulatory Care, Nursing Economics$, 30(4), 233-239.

Scope and Standards of Practice for Professional Ambulatory Care Nursing. 2010. 8th Edition. American Academy of Ambulatory Care Nursing.

Amstel, Margaret & Levine, June (2012). Perspectives in Ambulatory Care: The Value of Registered Nurses in Ambulatory Care Settings: A Survey. Nursing Economics $, 30 (5), 295-304.

TITLE 43. PROFESSIONS AND BUSINESSES CHAPTER 26. NURSES ARTICLE 1. GEORGIA REGISTERED PROFESSIONAL NURSE PRACTICE ACT

Georgia Board of Nursing 410-11-.01 Standards of Registered Professional Nursing Practice.

Amended: Filed Aug. 11, 2000; effective Aug. 31, 2000.

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