More than 25% of the RNs in the United States practice outside the hospital, a number that will only continue to grow as most health care services will be provided in outpatient, community, and home settings. The American Academy of Ambulatory Care Nursing (AAACN) has updated its description of the RN in ambulatory care:
"RNs provide high-quality, evidence-based care across the lifespan to enhance patient safety, reduce adverse events, impact and improve patient satisfaction, support and promote optimal health status, track admissions and readmissions, and manage costs within and among continually expanding, diverse and complex populations. Therefore, registered nurses are essential to the delivery of safe, high-quality care and should not be replaced by less skilled, licensed or unlicensed members of the healthcare team."
In an evolving healthcare environment, AAACN says maximizing the role of RNs will require "sustained forward movement" in several areas, including:
- RNs must be recognized and supported as leaders in the transformation of healthcare in the ambulatory care setting.
- RNs must practice at the top of their license, education and expertise to affect quality and cost through patient engagement, care coordination, enhanced teamwork, resource reduction, improved access and quality and outcome improvement.
- Faculty and schools of nursing must design undergraduate and graduate curricula to prepare nurses for new roles in ambulatory care.
- Health facilities must implement ambulatory care nurse residencies for new nurses and experienced nurses new to ambulatory care practice.
- Government and insurance carriers must recognize the impact on cost reduction that an RN can provide under new reimbursement models that are linked to improved outcomes.
- RNs must lead, participate in and support performance improvement activities designed to promote and enhance quality and safety, improve efficiency in care delivery, and evaluate impact on patient outcomes.
- Researchers must build the science of ambulatory care nursing by engaging in the development of new knowledge and innovation to build the evidence base needed to support quality practice.
"Nursing has embraced this challenge," says Debra Cox, MS, RN, president of AAACN. "We're doing this by creating a future that maximizes the RN's role in practice, education, research and leadership. This helps nurses achieve quality outcomes to better serve patients and their families across the continuum of care and through these challenging times."