Magazine article Nursing Economics

American Academy of Ambulatory Care Nursing Position Paper: The Role of the Registered Nurse in Ambulatory Care

Magazine article Nursing Economics

American Academy of Ambulatory Care Nursing Position Paper: The Role of the Registered Nurse in Ambulatory Care

Article excerpt

IN 2011, the American Academy of Ambulatory Care Nursing (AAACN) published the first-ever position statement regarding the role of the registered nurse (RN) in ambulatory care. Since that time, tremendous changes have occurred in health care, especially in ambulatory care. Healthcare reform, the Affordable Care Act, the implementation of care coordination as a strategy to improve health and prevent rehospitalization, and the transition from volume-based to value-based care have resulted in an increased focus on the ambulatory care setting as the site of health care provision now and in the future. This position paper reflects the current state of ambulatory care and the crucial role of the RN as a care provider, care coordinator, and care partner. It also highlights potential role changes and adaptations for the future.

Background

Health care is in the midst of unprecedented change. Improving the health of our nation will require reframing our healthcare system from one that emphasizes acute, episodic, interventional care to one that engages patients and providers in health promotion, disease prevention, and early intervention (Bodenheimer, Bauer, Syer, & Olayiwola, 2015). As a result, this enhancement of the Role of the Registered Nurse in Ambulatory Care position statement (AAACN, 2011a) reflects current trends and changes to the RN role in response to the changing healthcare environment.

Across the continuum of care, ambulatory care RNs work independently and collaboratively, partnering with patients, caregivers, providers, and other healthcare professionals in the design and provision of care in an ever-expanding array of settings. The context of the ambulatory care environment is complex, rapidly changing, and often difficult to navigate. Care delivery design and implementation is directly influenced by social determinants, environmental factors, and access to care issues that impact the patient's ability to adhere to a prescribed plan of care and obtain needed services (Fraher, Spetz & Naylor, 2015; Lamb, 2014; Smolowitz et al., 2014).

Concurrently, health care is evolving rapidly to meet the needs of an increasingly diverse and aging population. At the same time healthcare costs are driving value-based reimbursement and innovative models of care. Ambulatory care RNs are well-prepared to assume an expanded role in the design and delivery of high-quality care, defying traditional boundaries, and working in redefined interprofessional relationships, expanded community partnerships, and nontraditional healthcare settings.

The Importance of the RN in Ambulatory Care

* RNs provide high-quality, evidence-based care across the lifespan to enhance patient safety, reduce adverse events, impact and improve patient satisfaction, support and promote optimal health status, track admissions and readmissions, and manage costs within and among continually expanding, diverse, and complex populations. Therefore, RNs are essential to the delivery of safe, high-quality care and should not be replaced by less skilled licensed, or unlicensed members of the healthcare team.

* RNs are the team members best prepared to facilitate the functioning of interprofessional teams across the care continuum, coordinate care with patients and their caregivers, and mitigate the growing complexity of transitions in care.

* RNs play a critical role in the delivery of telehealth services and virtual care. The development of the art and science of telehealth nursing practice has improved and expanded coordination of healthcare services, reduced patient risk, and contributed significantly to care management models.

AAACN's Position Statement

Creating a future that maximizes the role of RNs in an evolving healthcare environment will require sustained forward movement in nursing practice, education, research, and leadership. Therefore:

* RNs must be recognized and supported as leaders in the transformation of health care in the ambulatory care setting (Institute of Medicine [IOM], 2010). …

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