Rebecca Newman, MS, RN, CPN, Children's Hospital of Colorado, Registered Nurse | Leondra Weiss, MN, ARNP, FNP-BC, C-EFM, AMB-BC, Family Medicine ARNP, Sea Mar Community Health Center
Updated: 05/18/25
Updated: 05/18/25
Purpose: The purpose of this survey was to better understand the knowledge and involvement in advocacy. The secondary aim was to capture the policy priorities of AAACN members.
Background: Ambulatory care nurses are in a unique position to address the increasing care demands, especially as health care shifts to outpatient settings. Historically, nursing as whole has faced barriers to gain full recognition for their contributions to patient care, particularly related to reimbursement for nursing care. This role, although complex and diverse, requires strong advocacy skills to ensure it can evolve and continue to address the growing needs of patients outside of hospital settings. The diverse and often siloed nature of ambulatory care nursing has made it challenging to find a cohesive voice to advocate for the profession and the diverse patient populations we serve.
The AAACN Advocacy Committee (previously the Legislative Committee) last surveyed AAACN members in 2019, prior to the pandemic. This information was used to help inform advocacy work and better meet AAACN member needs. It is imperative that we continue to raise the collective voice of ambulatory care nurses and stay the course in our advocacy efforts for ambulatory care nurses and our patients.
Methods: An online survey was conducted in Spring 2024 using a QR code, and emails were sent to the AAACN members' distribution list. The survey was comprised of nine items, including both multiple choice and free text question fields. Descriptive statistics were used to analyze quantitative data, while content analysis measured the frequency of policy priorities identified by members. The ambulatory care nursing conceptual framework was utilized to identify potential themes. Codes were assigned to like groups and content analysis was conducted using ATLAS.ti software.
Results: This survey was completed by 232 members, representing 5% of AAACN current membership. Most respondents worked in non-profit entities, with 58% non-direct patient care roles. Several questions were designed to assess knowledge and involvement in advocacy efforts. 34.9% of participants stated they were involved in organizational advocacy efforts. While approximately half of participants felt competent in their ability to impact organizational level policies, 63% reported that they were less knowledgeable about how to impact state and federal policies. Most participants felt knowledgeable about current legislative priorities. Free text responses captured participant legislative and regulatory priorities. A content analysis revealed five overarching themes: 1) professional practice and role of the ambulatory care nurse, 2) reimbursement, 3) staffing, 4) organizational workforce issues, and 5) workplace violence/safety.
Conclusion: It is imperative that organizations and policy makers recognize the value of the ambulatory care nurse voice in policy development and reform. Key priorities identified include articulating the key contributions of the ambulatory care nurse, ensuring full role optimization, addressing reimbursement for nursing services, standardizing staffing practices, and improving workplace safety. These insights helped to guide the AAACN Advocacy Committee in developing a unified platform with specific strategies to enhance member engagement. Proposed actions may include creating education resources, targeting social media messages, fostering strategic partnerships, and providing opportunities for direct policy advocacy at all levels.
Background: Ambulatory care nurses are in a unique position to address the increasing care demands, especially as health care shifts to outpatient settings. Historically, nursing as whole has faced barriers to gain full recognition for their contributions to patient care, particularly related to reimbursement for nursing care. This role, although complex and diverse, requires strong advocacy skills to ensure it can evolve and continue to address the growing needs of patients outside of hospital settings. The diverse and often siloed nature of ambulatory care nursing has made it challenging to find a cohesive voice to advocate for the profession and the diverse patient populations we serve.
The AAACN Advocacy Committee (previously the Legislative Committee) last surveyed AAACN members in 2019, prior to the pandemic. This information was used to help inform advocacy work and better meet AAACN member needs. It is imperative that we continue to raise the collective voice of ambulatory care nurses and stay the course in our advocacy efforts for ambulatory care nurses and our patients.
Methods: An online survey was conducted in Spring 2024 using a QR code, and emails were sent to the AAACN members' distribution list. The survey was comprised of nine items, including both multiple choice and free text question fields. Descriptive statistics were used to analyze quantitative data, while content analysis measured the frequency of policy priorities identified by members. The ambulatory care nursing conceptual framework was utilized to identify potential themes. Codes were assigned to like groups and content analysis was conducted using ATLAS.ti software.
Results: This survey was completed by 232 members, representing 5% of AAACN current membership. Most respondents worked in non-profit entities, with 58% non-direct patient care roles. Several questions were designed to assess knowledge and involvement in advocacy efforts. 34.9% of participants stated they were involved in organizational advocacy efforts. While approximately half of participants felt competent in their ability to impact organizational level policies, 63% reported that they were less knowledgeable about how to impact state and federal policies. Most participants felt knowledgeable about current legislative priorities. Free text responses captured participant legislative and regulatory priorities. A content analysis revealed five overarching themes: 1) professional practice and role of the ambulatory care nurse, 2) reimbursement, 3) staffing, 4) organizational workforce issues, and 5) workplace violence/safety.
Conclusion: It is imperative that organizations and policy makers recognize the value of the ambulatory care nurse voice in policy development and reform. Key priorities identified include articulating the key contributions of the ambulatory care nurse, ensuring full role optimization, addressing reimbursement for nursing services, standardizing staffing practices, and improving workplace safety. These insights helped to guide the AAACN Advocacy Committee in developing a unified platform with specific strategies to enhance member engagement. Proposed actions may include creating education resources, targeting social media messages, fostering strategic partnerships, and providing opportunities for direct policy advocacy at all levels.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 04/22/25
Updated: 04/22/25
Introduction: There has been rapid growth in the number of patients utilizing their patient portal to communicate with their healthcare providers since COVID. Despite guidance explicitly instructing people not to send messages related to urgent concerns, triage is still required of many client requests.
Background: Since November 2022, the primary care Epic MyChart messages of a midsized urban safety net health system (29% non-white; 63% primary language non-English) related to non-urgent medical questions and scheduling requests including report of symptoms have been routed to a centralized nurse triage department (NTD), averaging approximately 5500 messages monthly.
Problem addressed: Standard of care had been initiation of telephonic responses to messages warranting triage. A quality review of 200 calls over two weeks in June 2024 concluded that only 21% of initial calls resulted in message completion, and initial responses typically started at 48-business hours post-message receipt.
Methods: A project team including risk management and nursing and operations leadership was assembled. A literature search revealed no applicable studies have been conducted. A question posed on the AAACN telehealth community suggested other institutional workflows were consistent with ours.
Intervention: A standard message response was developed and approved in multiple languages, advising patients to call the NTD for further assistance. Nurses were instructed to scan messages for urgent or emergent concerns and respond with the standardized message if appropriate. Additionally, workflows were developed incorporating the primary care central scheduling team (CST). A “red flag” policy to guide non-clinical personnel on rapid identification of medical emergencies reported by offsite clients was updated to support CST screening of MyChart scheduling requests, including reported symptoms. The CST received 1:1 training on a new workflow entailing phone outreach and warm handoff to the NTD emergency line if a red flag symptom was reported or replying with the standard smart phrase in the patient’s preferred language.
Findings: Pilot of the updated workflows started in September 2024. Post-implementation quality review of 200 MyChart messages routed to the NTD on two dates in October 2024 showed 85% and 86% of patients following through with in reach after receiving the standardized message response. No “red flag” symptoms were reported among these messages. Time to initial message response decreased to 10 business hours on average. No relevant safety events have been reported.
Conclusion: Piloting a workflow for symptom-reporting patient portal messages that instructs patients on in reach to nurse triage has thus far resulted in a decrease in response times and an increase in nursing efficiency without compromising patient safety or quality of care in a diverse, safety net primary care patient population.
Background: Since November 2022, the primary care Epic MyChart messages of a midsized urban safety net health system (29% non-white; 63% primary language non-English) related to non-urgent medical questions and scheduling requests including report of symptoms have been routed to a centralized nurse triage department (NTD), averaging approximately 5500 messages monthly.
Problem addressed: Standard of care had been initiation of telephonic responses to messages warranting triage. A quality review of 200 calls over two weeks in June 2024 concluded that only 21% of initial calls resulted in message completion, and initial responses typically started at 48-business hours post-message receipt.
Methods: A project team including risk management and nursing and operations leadership was assembled. A literature search revealed no applicable studies have been conducted. A question posed on the AAACN telehealth community suggested other institutional workflows were consistent with ours.
Intervention: A standard message response was developed and approved in multiple languages, advising patients to call the NTD for further assistance. Nurses were instructed to scan messages for urgent or emergent concerns and respond with the standardized message if appropriate. Additionally, workflows were developed incorporating the primary care central scheduling team (CST). A “red flag” policy to guide non-clinical personnel on rapid identification of medical emergencies reported by offsite clients was updated to support CST screening of MyChart scheduling requests, including reported symptoms. The CST received 1:1 training on a new workflow entailing phone outreach and warm handoff to the NTD emergency line if a red flag symptom was reported or replying with the standard smart phrase in the patient’s preferred language.
Findings: Pilot of the updated workflows started in September 2024. Post-implementation quality review of 200 MyChart messages routed to the NTD on two dates in October 2024 showed 85% and 86% of patients following through with in reach after receiving the standardized message response. No “red flag” symptoms were reported among these messages. Time to initial message response decreased to 10 business hours on average. No relevant safety events have been reported.
Conclusion: Piloting a workflow for symptom-reporting patient portal messages that instructs patients on in reach to nurse triage has thus far resulted in a decrease in response times and an increase in nursing efficiency without compromising patient safety or quality of care in a diverse, safety net primary care patient population.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
