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.     

Making nursing-sensitive quality indicators real in ambulatory care

Pay-for-performance initiatives are changing the quality landscape. Gaps exist in quantifying and linking ambulatory care quality indicators to care provided by nurses in ambulatory care. Ambulatory care quality indicators that are sensitive to nursing care, standardized, and tested need to be identified and adopted by ambulatory care nurses, ambulatory care provider organizations, professional organizations, and endorsed by a consensus organization.     

Patient intensity in an ambulatory oncology research center: a step forward for the field of ambulatory care

Nursing leaders in ambulatory care need to objectively quantify patient intensity to balance patient care needs and nursing resources. In this three-part series the current literature on acuity/intensity tools will be reviewed, and the development of an Ambulatory Intensity System (AIS) to objectively quantify the nursing care will be described.     

Building a clinical ladder for ambulatory care

Finding innovative rewards for nursing service will be integral in meeting the challenges of future shortages of nursing staff. A clinical ladder is one tool worth exploring and perfecting to address those challenges. Exploration of a case study demonstrates a method for developing a clinical ladder. Steps and pitfalls in developing a clinical path are illustrated. Future uses, benefits, and opportunities for clinical ladders are suggested.     

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.     

Specialized new graduate RN critical care orientation: retention and financial impact

New graduate RN retention in the first year of employment is a challenge for hospitals, ranging from a low of 25% to a high of 64%. he objectives of this study were to determine the retention and costs associated with the employment of new graduate RNs before and after the initiation of a specialized year-long critical care orientation program. Retention was compared between two independent groups of graduate RNs in the critical care units of two tertiary hospitals in a multi-hospital health care system in metropolitan New York. The major study findings were a significant difference in retention between the two groups at 3 months, 9 months, and 12 months, and an annual financial savings related to decreased nursing turnover. Specialized orientation programs that support new graduate RNs have documented increased retention and decreased turnover. Health care finances are positively impacted by specialized orientation programs.     

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.     

The effectiveness of reminder phone calls on reducing no-show rates in ambulatory care

The objective of this study was to determine the effectiveness of daily reminder phone calls on reducing no-show rates in the ambulatory care setting. With the initiation of reminder telephone calls over a 6-month period, the no-show rate dropped by 50% from 8% to 4%. The no-show rate with reminder letters over 3 months was reduced by 29% from 8.5% to 6%. Reminding patients by telephone call 1 day prior to their appointment significantly increased the number of patients who arrived. Reminder phone calls also allowed patients to cancel their appointments if they weren't able to attend, rather than not showing up. Patients were given the option of rescheduling their appointments while on the phone at that time or calling back to reschedule. Most patients took the opportunity to reschedule at that time.     

Thinking outside the exam room: accessing community resources for patients in ambulatory care settings

Patients and families receiving care in the ambulatory care setting have increasingly complex needs, requiring nurses to employ a large variety of resources. Parents of pediatric patients have identified services available through community resources as a high priority, although medical personnel do not tend to appreciate the value of these services. Learning about the services offered by community agencies requires some investment of nursing time, but may result in improved effectiveness of nursing care across an institution or network of ambulatory care nurses.     

The value of waivers from the affordable care act

The Affordable Care Act requires health insurance plans to offer coverage without annual limits. This requirement began to be enforced in September of 2010, but some employers received special waivers that delayed the start of enforcement for them. Using data from the Center for Research in Security Prices (CRSP), we conduct an event study of the stock prices of these companies as their waivers were announced. We find that waivers do not lead to a statistically significant increase in the stock prices of waiver recipients.