Nursing Economic$

The United States spends more than other high-income countries on health care, while continuing to lag behind in quality, access, life expectancy, and care coordination. Patient populations and where they receive care is changing drastically, with volumes shifting from the inpatient, episode-centered model to an outpatient, health promotion centered model. Ambulatory care nurses are uniquely positioned within the healthcare continuum to lead the transformation of care for diverse patient populations. One strategy that enables the ambulatory care nurse to practice all dimensions of his or her specialty role is the development of a clinical advancement system(CAS). CAS, or clinical ladders, are one strategy that can assist nurses in acquiring skills necessary to support excellent practice as well as improve quality patient care outcomes.

Care planning and care coordination are quality metrics for Medicare Access and CHIP Reauthorization Act (MACRA). Registered nurses in ambulatory care were surveyed to assess current care coordination practices and identify opportunities for RNs to promote quality under the law. Findings can assist in understanding the ways nurses in ambulatory care currently contribute to quality outcomes and identify additional opportunities for registered nurses to lead efforts to continue to improve quality under MACRA.

The importance of establishing transition to practice and nurse residency programs in all practice settings is clearly supported in the literature. Developing a standardized program ensures use of evidence-based practice materials avoiding wide variance among curriculums. Investing in time to develop academic practice partnerships will promote necessary changes in nursing education as the role of the RN evolves. Partnerships provide an avenue to develop a new workforce that is not only directed at inpatient care, but also encompasses specialty care including ambulatory practice. As healthcare delivery continues to expand into non-hospital settings, demand for nurses in outpatient care will continue to grow. It is important ambulatory and community-based care settings play an active role in developing their own RN workforce.

The driving forces that are motivating many advanced practice nurses (APNs) to create new, high-value practices within the ambulatory care setting reflect the need for better, higher quality patient care, a deep commitment to spending healthcare dollars wisely, and most importantly, the relentless search for nursing interventions that lead to real improvement in the health of patients. Business planning provides the path through which new APN-run ambulatory practices become a reality and a success. A well-developed and sophisticated business plan is an essential first step in setting up a successful APN practice that reinforces APNs' contributions to health care, and leads to real rewards for patients and families, APNs, and the healthcare industry.

In the ambulatory care setting where care is episodic, occurs over time, and is impacted by multiple, interprofessional care team members, it is difficult to measure the specific impact of the registered nurse (RN). Many innovative processes are being developed and individual RNs are finding unique ways to benchmark quality that are nurse sensitive and improve outcomes for patients. The American Academy of Ambulatory Care Nursing Ambulatory Care Nurse-Sensitive Indicator Industry Report: Meaningful Measurement of Nursing in the Ambulatory Patient Care Environment focused on the clinical practice and the quality improvement/research role of the RN and identified nine clinical practice dimensions and three quality/research dimensions. Roles of the ambulatory care RN and exemplars classified according to those roles and dimensions are provided.

Ambulatory care registered nurses (RNs) have a pivotal role in educating, encouraging, motivating, and supporting patients to be engaged in their care and achieve their health care goals. To improve health outcomes, patients need to be engaged in attaining these goals. RNs are instrumental in this process and well-controlled studies will demonstrate their impact on helping patient’s engage in their care.