Blog » The Nurses Who Keep Patients Out of the Hospital

The Nurses Who Keep Patients Out of the Hospital

Created May 15 2016, 08:00 PM by Lippincott Solutions
  • ACA
  • ambulatory care nurses
  • Affordable Care Act

Monday, May 16, 2016

The role of the ambulatory care nurses is perhaps best illustrated by starting with what it isn’t: inpatient acute care nursing. Ambulatory care nurses work in the community, providing care to patients outside the hospital in a slate of settings that range from primary care to ambulatory surgery to outpatient clinics to telehealth service environments to patient homes and more.

“Professional ambulatory care nursing is a complex, multifaceted specialty that encompasses independent and collaborative practice,” explains the American Academy of Ambulatory Care Nursing, the specialty’s professional organization.  “The comprehensive practice of ambulatory care nursing is built on a broad knowledge base of nursing and health sciences, and applies clinical expertise rooted in the nursing process.”


While inpatient nursing usually involves several days with a patient and family, ambulatory care encounters can last as few as 15 minutes from the time the patient enters and leaves the room. Despite the relatively brief nature of such interactions, many ambulatory care nurses grow to know their patients over time through repeat visits, allowing for the development of meaningful, long-term relationships.

Because patient encounters are generally short, ambulatory care nurses must have top-notch assessment, consultation and follow-up skills. What’s more, ambulatory care often requires those skills to be used over the phone without the luxury of a face-to-face visit, so superior communication skills are important, too.

A unique challenge to ambulatory care nursing is that much of the patient care occurs outside the practice setting, provided by caregivers without formal healthcare training (e.g., the patient or a family member). Since ambulatory care nurses can’t oversee the day-to-day care themselves, they must work to ensure patients and families understand the procedures and rationale behind the care — and that they have the capabilities to manage it appropriately.

Ambulatory care nursing also requires its fair share of independence, expertise and rapid critical-thinking skills. Other healthcare providers may be in the office, but an ambulatory care nurse often deals with patients and families alone. A broad knowledge base and comfort providing evidence-based education and answers are must-have qualities for ambulatory care nurses to enjoy and to be effective in their environment.


For acute care nurses transitioning to ambulatory care roles, adequate support is crucial. Assuming ambulatory care is a cake job with bankers’ hours could not be further from the truth.

Kaiser Permanente established a 6-month residency program for experienced nurses transitioning from acute to ambulatory care after it noticed new ambulatory care nurses leaving jobs at high rates.

 “Anecdotal data from exit interviews reveal that these new nurses did not leave because they missed acute care, but because they were not well integrated into the ambulatory care setting, “ June Levine, MSN, RN, a national consultant in ambulatory nursing with Kaiser Permanente, Pasadena, CA, told Medscape.

“It can be difficult, particularly for expert-level nurses to return to the role of advanced beginners. Without a thoughtful transition strategy and visible support, nurses often didn’t stick with ambulatory care long enough to appreciate its rich diversity.”


With its focus on prevention, primary care and keeping patients away from expensive hospital-based treatments when possible, the Accountable Care Act has increased demand for ambulatory care nurses. Healthcare reform has also expanded the number of Americans with insurance coverage, further multiplying the pool of patients seeking outpatient services for both acute and chronic conditions.

“Registered nurse employment is expected to grow most rapidly in outpatient settings — particularly physician offices — and home health care,” wrote  Joanne Spetz, PhD, FAAN, a professor in the school of nursing at the University of California, San Francisco, in Nursing Economics.  “In these settings, RNs will be expected to serve as care coordinators, case managers, patient educators, and chronic care specialists. Strong skills in these areas can be developed on the job, but many RNs will find that additional formal education, either through certificate programs or degree-offering programs, will be advantageous.”

Ambulatory care offers challenge, diversity and plenty of opportunity. As more patients seek care outside the hospital, ambulatory care nurses will play a key role in their success.

Don’t miss the American Association of Ambulatory Care Nursing (AAACN) Annual Conference taking place this week from May 18 – 21 in beautiful Palm Springs, CA. 

Stop by and see us in booth 300 and learn how Lippincott Solutions and AAACN are working together to make evidence actionable for ambulatory care nurses!