Nursing Economic$

The nation has been on a quest to advance quality in providing health care services and improving patient outcomes. The challenge has been to identify and define metrics that will demonstrate improvement. Acute care settings have a fairly well-established system of quality measurement, but ambulatory care systems are in less-developed stages. Imperative to accurate quality measurement in ambulatory care is to identify and define metrics that reflect the value of registered nurses to improved patient care and outcomes as well as to the organization. The American Academy of Ambulatory Care Nursing (AAACN) established a task force to determine appropriate measures of nursing quality. The task force spent 2 years investigating measures and produced an Industry Report that addresses measures of nursing quality. This article is the first in a series of articles that will reveal and discuss the contents of the Industry Report.

The American Academy of Ambulatory Care Nursing’s Nurse-Sensitive Indicator Task Force was charged with identifying and developing meaningful measures for the ambulatory care environment. Several strategies were used to identify measures that would reflect the value of the role of the nurse in this setting. One such strategy was to conduct a comprehensive review of the health care environment as a whole and the measures within it, to identify measures that already existed that could easily be adapted to the role of the nurse in ambulatory care settings. Because of the complexity of the ambulatory care patient care environment, the group sought to reach momentum in indicator development by starting with the proposal of measures that would be less complex to develop, pilot, and adapt in organizations across the country.

Written by members of the AAACN and edited by Kitty M. Shulman, MSN, RN-BC

The delivery of health care is quickly changing from an acute care to a community-based setting. Faculty development and mastery in the use of new technologies, such as high-definition simulation and virtual communities are crucial for effective student learning outcomes. Students’ benefits include opportunities for hands-on experience in various patient care scenarios, realtime faculty feedback regarding their critical reasoning and clinical performance, interdisciplinary collaboration, and access to a nonthreatening learning environment. The results of this study provide some evidence of the benefits of developing faculty and nursing curricula that addresses the shift from an illness-based, acute hospital model, to a community and population health-based preventive model.

Ambulatory nursing care can be difficult to comprehend in all its complexity. In August 2013, the American Academy of Ambulatory Care Nursing commissioned a task force to identify nursing-sensitive indicators specific to ambulatory care settings. Given the great variation in settings, staff mix, patient populations, role dimensions, skill sets, documentation systems, and resources, determining metrics that apply across the entire continuum of care is a daunting task. However, it is incumbent upon nurse leaders to define the metrics that will promote the value of the registered nurse in ambulatory practice and care coordination. Once initial measures are identified, piloted, and validated, the infrastructure can be created for ongoing benchmarking and collaboration. The long-term goal is to leverage professional nursing practice, based in the ambulatory care setting, to improve quality, safety, and cost in health care.

The Patient Protection and Affordable Care Act (2010) established clear provisions for Patient-Centered Medical Homes and Accountable Care Organizations. In both, care coordination and transition management are methods to provide safe, high-quality care to at-risk populations such as patients with multiple chronic conditions. The emphasis on care coordination and transition management offers opportunities for nurses to work at their full potential as an integral part of the interprofessional team. Development of a model for the registered nurse in care coordination and transition management provides nurses the opportunity to develop the knowledge, skills, and attitudes to be a resource to the team and to patients, and to contribute to high-quality patient and organization outcomes.

Ambulatory care nursing has emerged as a distinct professional nursing specialty. Many characteristics differentiate ambulatory care nursing from other specialty practices, including the settings, the characteristics of the patient encounters and the focus upon groups, communities, and populations, as well as individual patients and their families. A conceptual framework for ambulatory care nursing was developed in 1998 and recently revised, through consensus of leaders in the specialty. The key elements of the Ambulatory Care Nursing Conceptual Framework are the patient, the environment (both internal and external), and the nurse, practicing in three major roles.