Industry insiders have predicted that healthcare will progressively move into ambulatory settings over the next decade.
Why? There are several reasons. The Affordable Care Act (ACA) has expanded access to health insurance for millions of previously uninsured consumers, who are now seeking primary care. There is also a trend toward fewer hospitalizations, as routine surgeries are increasingly done in ambulatory surgery centers. The greater focus on wellness, prevention, and disease management efforts designed to reduce complications is also keeping patients out of the hospital – and helping to expand patient volume in physician practices. The direct result is expanded opportunities for nurses in ambulatory care settings, in new roles that emphasize care coordination, chronic disease management,and telenursing.
Special Area of Focus
Ambulatory care is recognized as a distinct nursing specialty, complete with a board certification
process. It is different from traditional “bedside” nursing not only in terms of the setting, but in terms of the characteristics of patient encounters. In the hospital, nurses follow patients closely and see them continuously in a very controlled environment until they are well enough to go home. In ambulatory care, the patient flow is very different because care is delivered episodically – often for as little as 15 minutes at a time. And rather than controlling the care environment and providing direct care, nurses largely perform patient assessments and then guide patients toward healthy behaviors and self-care management activities. Increasingly, RNs with job titles like nurse navigator and care coordinator are helping patients steer their way through an intricate and complicated healthcare system.
Jobs in ambulatory care are not limited to private physician practices. Other settings include retail clinics, urgent care centers, schools, cancer treatment facilities, ambulatory surgery centers, correctional facilities, and home health agencies.
Increasing Need for Nurses
Ambulatory care is growing more complex as the population ages – more and more patients have multiple chronic conditions that present challenges to the clinicians who must manage them. So there is a growing need for more and better prepared nurses – the days of the nurse who merely checks and records vital signs before a patient sees the doctor are numbered. Physician practices increasingly rely on nurses with excellent clinical skills to help manage patients with diabetes, congestive heart failure, hypertension, cancer, and other chronic diseases. In a role like this, nurses must have a clear understanding of the natural course of a disease within a target population (see our post on population health management
) and the effects of specific interventions at critical points in order to assertively prevent complications.
As ambulatory care increases in importance, there will also be expanded opportunities for nurses who are skilled in telenursing
, which encompasses all types of nursing care delivered with the aid of technology to remove time and distance barriers. Remote monitoring is becoming especially popular – patients use devices in the home to collect and transmit medical data to clinicians for interpretation, in some instances eliminating the need for home nursing visits. When nurses are monitoring patients remotely, they can eliminate travel times and see more patients each day. A large body of evidence suggests that telenursing produces outcomes equal or superior to those seen with traditional clinical encounters.
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