The intent of this position statement is to recognize and communicate the value and the unique practice of ambulatory nursing care in this rapidly changing and evolving healthcare setting. The need for care provided by a registered professional nurse is essential and such care cannot be provided by unlicensed assistive personnel.
The New York State Nurses Association:
Ambulatory care nursing, previously defined by the setting and the length of the healthcare encounter, has evolved into a specialty whose practice setting emphasizes health promotion and disease prevention and nursing care with extensive patient and family involvement. The continuing growth of ambulatory care services, whether they include outpatient surgical centers, medical offices or specialty clinics, is even more apparent since the onset of managed care that initiated the decline in hospital inpatient census and resulted in a greater need for outpatient care services. Ambulatory care nurses are facing issues such as the use of the increasingly desirable and less invasive technologies; an aging population; the need for education, clinical expertise and competence in disaster preparedness; and such workplace issues as the nursing shortage and the necessity of adapting to doing more with fewer resources. The healthcare delivery system will continue to change, and nurses will be challenged to provide alternative care delivery methods such as telehealth and on-line clinics.(Nowicki & Haas, 2003)
The ambulatory care setting employs a variety of personnel who carry out the functions essential to the daily operations. The registered professional nurse coordinates the activities carried out by both licensed personnel and unlicensed assistive personnel (UAP). Unlicensed personnel (UAPs) perform the non-nursing health-related activities in this setting. The delegation of responsibilities to other licensed professionals, and the assignment of activities to unlicensed assistive personnel requires professional judgment and knowledge of the roles of both licensed and unlicensed personnel as well as the laws, rules and regulations that govern nursing practice. Registered professional nurses practicing ambulatory care nursing include generic, advanced and specialty-educated practitioners. Implementation of the core components of the ambulatory care nursing role and utilization of ambulatory care nurses (RN, LPN, NP) and assistive personnel varies significantly across ambulatory care settings.
The American Academy of Ambulatory Care Nursing and the American Nurses Association have defined professional ambulatory care nursing as “those clinical, management, educational, and research activities provided by registered nurses for and with individuals who seek care for health-related problems or concerns or seek assistance with health maintenance and/or health promotion. These individuals engage predominately in self-care and self-managed health activities or receive care from family and significant others outside an institutional setting.”(Nowicki & Haas, 2003) The provided services are episodic, less than 24 hours in duration and may be evidenced by one visit or a series of visits that may last days, weeks, months or even years.("American Academy of Ambulatory Care Nursing and American Nurses Association," 1997) Communication between the nurse and the patient may take the form of personal visits or telephone contact and the emphasis is on assisting the patient and family to maximize wellness and minimize the symptoms of acute and/or chronic conditions.
The Ambulatory Care Nursing Conceptual Framework was developed in 1998 by members of the American Academy of Ambulatory Care Nursing and divides the practice of ambulatory nursing into broad role categories: “Clinical Nursing, Organizational/Systems, and Professional.”(Nowicki & Haas, 2003). Within each of the broad practice categories, the indispensable knowledge and skills were categorized. A link to the American Academy of Ambulatory Care Nursing's web site is included www.aaacn.org.
Reprinted from AAACN Viewpoint, 2003, Volume 25, Number 2, p. 14. Reprinted with permission of the publisher, The American Academy of Ambulatory Care Nursing (AAACN)., East Holly Avenue Box 56, Pitman, NJ 08071-0056. Phone (856)256-2300; FAX (856)589-7463.
The New York State Nurses Association recommends that registered professional nurses practicing in ambulatory care:
Approved by the Board of Directors on 9/18/96, Reviewed and revised by the expanded Council on Nursing Practice on 8/13/04, Approved by the Board of Directors on 9/15/04
Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.
American Academy of Ambulatory Care Nursing and American Nurses Association. (1997). Nursing in ambulatory care: The future is here. Washington, DC: Author.
Futch, C., & Phillips, R. (2003). The mega issues of ambulatory care nursing. Nursing Economic$, 21(3), 140-142, 147.
Kowal, N., & Hoare, K. (2003). Practice evaluation and research committee launches staffing study, Viewpoint (Vol. 25, pp. 13-14): AACN.
Nowicki, C., & Haas, S. (2003). Ambulatory care nursing conceptual framework, Viewpoint (Vol. 25, pp. 14). AACN.
Schim, S. M., Thornburg, P., & Kravutske, M. E. (2001). Time, task and talents in ambulatory care nursing. Journal of Nursing Administration, 31(6), 311-315.
Swan, B. (2003). Choosing outcome measures in ambulatory care, Viewpoint (Vol. 25, pp. 16): AACN.
Swan, B., McGinley, A., & Lang, N. (2002). Ambulatory care nursing practice: Developing and contributing to the evidence base. Nursing Economic$, 20(2), 83-87.
For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.