Chapter 5: Ambulatory Care Operations

Chapter 5: Ambulatory Care Operations

Identification: AMBP020v2019c05
Expiration Date: December 31, 2023
Credits (Post Test and/or Evaluation Required)
Available until 12/31/2023
  • 1.40 - CH


Continuing Education Instructions and Disclosure Information:

  • Contact hours available until 12/31/2023.

Requirements for Successful Completion:

  • Complete the learning activity in its entirety and complete the online CNE evaluation. You will be able to print your CNE certificate at any time after you complete the evaluation.

Faculty, Planners, and Authors Conflict of Interest Disclosure:

  • There are no disclosures to declare

Commercial Support and Sponsorship:

  • No commercial support or sponsorship declared

Accreditation Statement:

  • This educational activity is jointly provided by Anthony J. Jannetti, Inc. (AJJ) and AAACN.
  • Anthony J. Jannetti, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
  • AAACN is a provider approved by the California Board of Registered Nursing, provider number CEP 5366.

Learning Outcome:

  • After completing this learning activity, the learner will be able to identify important functions in managing and working within the operation of an ambulatory care setting.

Learning Engagement Activity:

  • Staffing in an ambulatory care unit is complex, and attempts to develop acuity tools or staffing benchmarks have been largely unsuccessful. In your own work setting, what are the factors that impact the number of nursing and ancillary staff needed on various days?

Note - only CE Evaluations are available online.

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Chapter 5: Ambulatory Care Operations

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Daisy Macasaquit
11/9/22 3:36 pm

I work in a larger primary care with over 60 providers- with a set up as: clinical support staff (medical assistants) directly report to the operational manager; RN's, LPN's and NP's reports directly to the Nurse director; medical providers report to the Medical director; social workers report to their Manager. For many years we had struggled with quick turn over of leadership and staffing throughout the disciplines; on top of staffing shortages, increasing patient needs, insurance reimbursement requirements and restrictions, limited clinical spaces and community resources. We as a small group of clinical nurses have been impacted by all these, since we serve as the core group coordinating all these disciplines to ensure safe delivery and efficient care to our client population. We feared safety of our practice and unable to advocate for our patients. We however, were able to maintain a respectful and open dialogue with our leadership, and got rewarded with a nursing director whom we now closely work with enforcing these changes/improvements. We now have someone coordinating these task at a management level with other disciplines. Understanding work flow of other staff and services they offer helped us coordinate better care to our patients. And same goes if they know what we nurses do, which also promotes healthy work relationship.

Tiffany Pryor
1/10/23 8:41 pm

Our greatest staffing issue at our primary care officesseems to be accountability and structure. In these challenging healthcare times, it's difficulty to have punitive actions towards staff who have excessive tardiness and abscenses when there is the reality that terminating a caregiver in critically staffed situations would only further the shortage. In addition, morale is low when new caregivers see lack in structure and great variation in workload and accountability between them and the cargiver working alongside them. As a newly formed organization that is combining smaller PCP groups into one larger group, I see a more cohesive staffing model to come and help with this burden.

Sarah Sylvia
1/24/23 5:05 pm

I work in an outpatient infusion center where we see 45-55 patients everyday. How many nurses and aids that are needed on a given day depends on many factors. The types of patients we are treating whether they be more ambulatory or need a lot of help. If these patients are new or first timers at the infusion center and need a lot of extra attention impacts the amount of staff we need. Certainly the sheer number or value of patients impacts care if I have a couple extra patients in a given day, I can't always help do all the extra stuff and need more help from support staff. Who is working certainly impacts care, if there are nurses and aids filling in from our other unit somethings things are done differently and this will impact flow leading to the need for staff or at least the staff that is there all the time to maybe have to do more. Who my nursing buddy or aid is for the day and the way we work together and communicate impacts care and the need for more or less staff. We often have problems with patients that arrive late or patients that have to stay late and run out of space for a given time. This impacts flow and staffing in the infusion center. Difficulty communicating with certain providers to provide appropriate orders or help in an emergency may take extra time away from one nurse, leading to the need to have extra staff covering for those that are unavailable. A floating nurse or charge nurse may then need to step in as an extra person in order to complete tasks. We rely on other departments like pharmacy, offices, lab in order to complete nursing tasks and this impacts flow and staffing for the day. If they are inefficient if often will make us inefficient.

Jamie Hillsberry
4/18/23 11:12 am

I work in an outpatient setting for adult and pediatric infusions. Our unit can see up to almost 50 patients or so per day. Our nurse manager will look at the schedule and see how many nurses and nurse aids will be needed for that particular day. I do know we can have some staffing issues and shortages which can make things more difficult, especially if we only have one nurse aid instead of two. This type of staffing issue can create more strain and stress on our one nurse aid and fellow nurses because more responsibility will be placed onto the nurses which then takes time away from their patients. I feel this is a huge safety issue and can cause potential errors when a nurse is required to rush and not take their time and be efficient. Adequate staffing will always be a long-term issue that will need constant attention in the present and future areas of all nursing.

Johanna Valencia
9/27/23 11:28 am

In your own work setting, what are the factors that impact the number of nursing and ancillary staff needed on various days? Johanna Castillo 11/9/23 I work in an MRI center where the hours of service 7am until 10pm Monday through Friday and Saturday from 7am to 4:30pm. One of the factors that affect the number of nurses and ancillary staff needed depend on the season. Usually around December and January there are less patients due to holidays and high deductibles that a patient has to pay for their scan. Nursing is a new concept at my institution. Currently we have two nurses. One of the nurses was just hired 3 months ago. So, we are still in the process of developing and defining roles and responsibilities for the nurses. For the MRI technicians, however, there seems to be a statewide shortage, but also the turnover is high due to the amount of stress placed on the technologist.

Dane Faul
11/8/23 2:48 pm

This is a work in progress at my clinic, but the number of providers impacts the amount of nursing staff at my clinic. We recently have experienced a lot of growth at my family practice clinic, so it has increased the amt of nurses we have on board. It is hard to quantify acuity in the clinic, and some days we have more acute triages than others, for example, but so far we have gone by the amount of porviders we have and the amt of patients that we see.

Marisol Lopez
11/30/23 8:57 pm

Working at an urgent care facility, not every day is the same. Our clinic only consists of 4 RN's (rotation) and a combination of NA's or MAs and xray technicians along with 3-4 providers at a time. On any given day it is usually 1 RN, 2-3 NA/MAs and 1 xray tech along with 3 or 4 providers. A lot of factors impact the number of staff needed for different days. For example, I live in a quite touristic location and during the summer we have a festival in early July and have people from all around the country come for the festival. During these busy times we know that we must be staffed appropriately to meet the high volumes of patient that come through urgent care. Many of whom are not local, go to Urgent care for any medical need during their vacation time. During other times of the year, we know that weekends are also busy, because most providers are not open on the weekends or after hours and so, a higher volume of patients tend to visit our urgent care. Staffing during the weekend is also more highly needed than perhaps a mid-week. At last, Holidays, just like summer times, people on vacation mostly use an urgent care during their travels for medical needs.