Sending Out an SOS: Defining an Institution’s Ambulatory Care Interdisciplinary Scope of Service

Patient care is not provided by nurses alone, but is provided by an interdisciplinary team with different education levels, training, and practice guidelines. In a large academic medical center with over 70 specialty clinics spread over a large urban area, it was difficult to standardize clinical duties. A foundational guidance document, “Scope of Service for Healthcare Personnel in Ambulatory Care” (SOS), defining the scope of clinical duties for nurses and medical assistants existed. However, the document only represented a small sample of clinic roles in the ambulatory care setting and did not provide comprehensive guidance for leaders and staff.

Due to a wide variety of roles and insufficient resources, a knowledge gap was identified. The gap was measured by the number of questions submitted to the clinical education department by clinic leaders regarding other job roles’ license or certification practice parameters. A group of key stakeholders worked to build upon the foundational document to encompass additional ancillary roles. Thus, a source of truth was created for the clinics to refer to decrease variation of practice to benefit both patients and staff.

Since its inception, the SOS document has grown to include 16 clinical roles and 70 patient care tasks. Any requests for edits to the SOS document are reviewed by clinical nurse educators, ambulatory care practice council (APC), and nurse executives by a shared governance process. The clinical nurse educators assess the request’s consistency with state regulations (if applicable), academic degree plans, certification program requirements, and on-the-job training pathways for each discipline. Best practices in current clinic workflows at the institution, professional organizations, and other large academic medical center ambulatory care practices are reviewed as well. Additionally, experts in each discipline are consulted for role specific evidence-based practices. This resource serves as safeguard for clinic leaders to ensure that staff are practicing appropriately within their role limitations. Abiding by the SOS document’s boundaries can provide protection for the staff’s licenses and certifications while they deliver safe patient care. This resource also provides staff with information required to function at the height of their credentials, therefore increasing staff satisfaction and retention. For easy access, the SOS document is available on the institution’s ambulatory care SharePoint site.

Since the release of the document, the number of questions related to clinical practice has declined, emphasizing its value for clinic leaders. The need for this document is also supported by the number of times it has been accessed on the ambulatory care shared site; the latest version has been viewed 937 times since being published in December 2020. Due to the document’s utility and applicability, institutional research department leaders requested a review of their roles and tasks to create a similar tool for research personnel to reference their practice parameters. This document has proven to be perpetually evolving, as there are several new requests for role additions currently being reviewed and considered. With every update to this document, the facility moves one step closer to optimizing our most valuable resource: amazing clinical staff.