Resourcing evidence-based practice in ambulatory care nursing

Ambulatory care nurses may benefit from not only developing knowledge and skills in evidence-based practice (EBP), but also in identifying and providing sufficient resources for EBP to be implemented and sustained. Organizations should select one of the five conceptual models available in the literature to guide development and implementation of EBP. Costs of implementing and sustaining EBP include expert consultation, facilitators, staff time, informatician time, and data management. Benefits of EBP include improvements in patient care quality and safety, as well as regulatory compliance and risk management. Resources supporting EBP include professional literature available via the Internet and databases or agencies, such as ARHQ, professional organizations, and funding through grants.     

Validation of a taxonomy of ambulatory nursing practice

Ambulatory care is a complex and challenging nursing specialty. This survey of 33 ambulatory nursing administrators addressed the roles and responsibilities of nurses in ambulatory care settings.     

Linking nursing workload and performance indicators in ambulatory care

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support.     

Leapfrog standards: implications for nursing practice

Annually, thousands die unnecessarily as a result of preventable medical errors. Medical literature supports use of evidence-based standards to increase safety and improve the quality of health care. Nursing implications from three imposed standards are examined.     

Health care reform: current updates and future initiatives for ambulatory care nursing

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.     

Nursing resource applications through outcome based nursing practice

Nursing resources were reapplied in cardiac care as a result of investigating the episode of illness in terms of patient outcomes. Change was necessitated by scarcity of beds, competition for patients, capitation, and high cost of care. The interdisciplinary approach resulted in increased customer satisfaction, positive outcomes, and cost avoidance of $46,000 the first year.     

Incorporating the National Guideline Clearinghouse into evidence-based nursing practice

The National Guideline Clearinghouse (NGC) can be used as a means of integrating the constantly growing and changing body of scientific clinical evidence into the artful practice of nursing. The NGC offers an extensive collection of peer-reviewed, current, scientific standards to support clinical decision making in nursing practice. Nurse leaders should take a leadership role in bringing these relevant resources and new nursing knowledge to policy and procedure committees for active consideration.     

Impact of disease management programs on hospital and community nursing practice

The impact of disease management progrmms on the role of the nursing profession in the evolving U.S. health care system is reviewed. Needed changes in educational and training programs are discussed in relation to demands for changing clinical and administrative skills in nursing with an emphasis on increasing demand for advanced practice nurses.     

Expanded role of nursing in ambulatory managed care. Part I: Literature, role development, and justification

New expanded roles in nursing are developing in response to the health system switch from private, episodic care of individuals to health maintenance organizations (HMO's) focusing on disease prevention and promotion of health for populations of persons with chronic illness. This evaluation project explored the role of the nurse clinician in population and case management at a large HMO in the Northwest United States. In Part I of this two-part series, a literature review, is presented on chronic illness, ambulatory nursing, expanded role nursing, and nursing in HMOs. The development of the expanded role nurse clinician at the managed care organization is also described. Results could be used by HMOs to attract and retain nurses, improve care processes, and decrease costs in ambulatory care.