Reflections on Ambulatory Care Nursing and the Impact of the Clinical Nurse Specialist

Abstract

Objective The aims of this study were to identify and discuss reflections of ambulatory care nursing and the integral role of the clinical nurse specialist (CNS) in defining nursing practice in the ambulatory care setting. Description of Project Three CNSs and a CNS student, all assigned to the ambulatory care setting, discussed their experiences supporting nursing practice in the ambulatory care setting. Major reflections were identified, organized, and then expounded from personal experiences and published studies to highlight the impacts of the CNS in ambulatory care nursing. Outcomes Four major reflections were identified: ambulatory nursing is complex, ambulatory care nursing is in its infancy, ambulatory care nursing adds value, and opportunities exist for measuring the impact of ambulatory care nursing. Progress is being made in determining the role of the nurse in the ambulatory care setting, but more work is required. The CNS is prepared to define nursing practice in the ambulatory care setting and develop nursing-specific resources that support nurses in practicing to the full extent of their licensure. Conclusion The ambulatory care setting is expected to support the majority of the healthcare needs of the future. Ambulatory care nurses are well suited to meaningfully contribute to patient care. Evidence-based nursing practice in this setting is vital to ensure safe, quality patient care.

Developing New Clinical Nurse Specialist Educational Opportunities in Ambulatory Care Settings

“…The CNS is uniquely prepared to improve health and patient experiences of care and to reduce the cost of care in complex patient populations and care settings by addressing the 3 spheres of impact—patients and families, nursing staff, and healthcare systems 7 . Traditionally, CNSs have used their knowledge and expertise to improve outcomes in the hospital environment, but shifts in the provision of outpatient care in ambulatory and community settings present new and exciting opportunities to increase the scope of impact 15 …”

“…Rural health disparities are further magnified in racial and ethnic minority and low-income populations. The CNS is uniquely prepared to effectively manage patients with chronic health conditions such as diabetes, heart failure, and cardiovascular disease through their expertise in both clinical care and healthcare systems 15,17,18 . In addition, the care of individuals with chronic health conditions should be provided by clinicians with competencies in project management, data analysis, and the use of technology in patient care settings, as is the scope of practice of the CNS 17 .…”

“…7 Traditionally, CNSs have used their knowledge and expertise to improve outcomes in the hospital environment, but shifts in the provision of outpatient care in ambulatory and community settings present new and exciting opportunities to increase the scope of impact. 15 For nearly every health metric, rural communities fare worse than urban areas. 16 Rural health disparities are further magnified in racial and ethnic minority and lowincome populations.…”

“…The CNS is uniquely prepared to effectively manage patients with chronic health conditions such as diabetes, heart failure, and cardiovascular disease through their expertise in both clinical care and healthcare systems. 15,17,18 In addition, the care of individuals with chronic health conditions should be provided by clinicians with competencies in project management, data analysis, and the use of technology in patient care settings, as is the scope of practice of the CNS. 17 Although the CNS curriculum effectively addresses such competencies in hospitalbased settings, being effective in caring for individuals with chronic health conditions across the healthcare continuum and outside the hospital walls requires a creative and innovative approach, utilizing community partners to provide relevant and meaningful clinical experiences for students.…”

The Clinical Nurse Specialist Entrepreneur

“…The benefits of transitioning this physician-owned practice into an NLC were evident, and the CNS is well suited for success in the ambulatory care setting. 24 Extensive planning, financial competency, and a mindset for innovation during the development of this business plan were pivotal for success. This project provided the opportunity to improve upon an already successful business by creating a sustainable healthcare model that will provide exceptional care from APRNs to the de-identifying the town community for years to come, which can serve as a future model for CNS entrepreneurship in the NLC.…”