Purpose: At a large NCI-designated ambulatory care cancer center, nurses play a vital role in coordinating the ongoing care and complex needs of patients. Functioning to the full scope of licensure, nurses’ responsibilities include complex care coordination, telephone triage, and patient education. Coordination of care necessitates accomplishment of many tasks including disability paperwork, patient-requested letters, insurance prior authorizations, and outside referrals, and often are deferred tasks. Balancing necessities of care coordination, clinic leaders and front-line staff recognized the opportunity to expand the practice of medical assistants to work to full scope of licensure. Development of new and expanded medical assistant (MA) roles have been identified in the literature as an opportunity to transform and improve workflows within ambulatory care clinics (Chapman & Blash, 2017). The purpose of this project was to evaluate the feasibility of imbedding a back office medical assistant (BOMA) into a disease-specific nursing team, with the goal of promoting effective and timely coordination of care.

Description: Clinic nurses were surveyed to capture current state and elements of care coordination tasks. Analysis of the data identified opportunities to reassess and distribute elements of care coordination for nurses and MAs. A team (a clinical nurse educator, a medical assistant supervisor, a nurse manager and several front-line nurses) convened to create a 6-week orientation pathway for the BOMA. The team identified important components of the orientation including documentation in the electronic medical record, communication pathways within the clinical team, and workflows for common care coordination tasks. Standard work documents were used as training tools and additional job aids were developed. A work space for the BOMA was created within the nursing workroom to facilitate communication and foster teamwork. To better understand disease-specific workflows, the BOMA was included in weekly nursing team meetings. Formal precepting was provided by the clinical nurse educator to ensure clinical knowledge and skill attainment. Four months after the implementation of the BOMA, the survey was repeated to evaluate efficacy and implications of this new role.

Evaluation/outcome: Evaluation of survey results demonstrated the addition of the BOMA role promoted efficient care coordination. Nurses surveyed reported the BOMA improved the team’s ability to provide effective and timely care to patients. The BOMA reported higher job satisfaction through this collaborative team environment as well as professional growth with the expanded responsibilities. Implementation of a dedicated disease-specific BOMA has provided a valuable resource to the clinical team. Analysis also revealed reduced deferment of tasks while also a positive trend of increased nurse ability to take dedicated breaks. The evaluation of the project successfully illustrated that functioning to the full scope of nurse/MA licensure improves care coordination and job satisfaction while strengthening collaborative teamwork. The implementation of disease-specific BOMAs will now be expanded into other clinical nurse teams throughout the institution.

References
1. Chapman, S. A., & Blash, L. K. (2017). New Roles for Medical Assistants in Innovative Primary Care Practices. Health Services Research, 383-406.

Naomi Heinecke LPN

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