Ambulatory Care: Nurses Leading the Way

There is an exciting paradigm shift from inpatient to ambulatory care in healthcare. This comprehensive metropolitan cancer center identified that ambulatory care nurses needed confidence and competence in the complex skill set required to ensure quality and safe patient outcomes. In response, a series of courses were designed to facilitate transitioning nurses to be leaders in the ambulatory care setting.

The ambulatory care nurse role is unique and requires a specialized skill set that goes beyond traditional acute care. As this shift generates new and experienced nurses into the ambulatory care setting, this drives a need for a focused and formal education (American Academy of Ambulatory Care Nursing (AAACN), 2018). To facilitate successful role transition this organization developed an evidenced-based, continuing education course, the role of the oncology nurse in the ambulatory care setting. This course is patterned after national professional organization standards, regulatory requirements, state, and internal policies and guidelines.

Comments from post-evaluations recognized the need for broadened education. In response, an ambulatory care nursing role series evolved to consists of three courses. The role of the oncology nurse in the ambulatory care setting, which focuses on developing skills for the RN to be poised to lead the ambulatory care team, including role components, coordinating care, and effectively communicating within internal and external environments to promote quality care for the patient and the family. A debrief is conducted one-month post-attendance. Participants are reporting a positive change in their nursing practice. A post-formative assessment revealed a 25% increase in knowledge. The role of the oncology nurse in telephone triage provides the nurse with tools and resources necessary for this unique role, including symptom management protocol, effective communication, ethical and legal situation management, and proper ergonomics. The Greenberg model is utilized, providing the basis for guiding practice to implement care within a clinical setting. Learning is validated through simulation and role playing, with observed skill improvement. Participants complete a post-formative assessment, and a 43% growth in knowledge was appreciated. Lastly, documentation in the ambulatory care setting plays an important role in coordination of care. The role of documentation in the oncology ambulatory care setting explores state-of-the-art best practices to provide the nurse with the understanding of the value of clinical documentation. Documentation outcomes are being measured collaboratively with the quality and safety department.

All three post-course evaluations show an 85-95% satisfaction rate, and staff report the ambulatory care series as valuable to their role and describe it as “overdue,” “more confident in my role,” and “extremely valuable.” Next steps include creating content to support the recent expansion of telehealth in the ambulatory care setting.

The multifaceted and complex setting of ambulatory care is rapidly growing, and the roles are expanding. The ambulatory care nurse is the leader of outpatient care and the liaison for the patient, the family, and the community. The RN new to professional ambulatory care requires specific knowledge, tools, resources, and support to lead the future of the evolving ambulatory care setting.