Shifting Health Care System Fuels Profound Changes In Nursing, Patient Care Outside the Hospital

September 27, 2012
Contact: Janet D'Alesandro

The American Academy of Ambulatory Care Nursing releases position paper on the increasingly crucial role of the outpatient RN

Pitman, NJ - The groundswell of change in health care delivery from inpatient to outpatient settings continues to build. The American Academy of Ambulatory Care Nursing (AAACN) has released a landmark position paper clarifying the pivotal role of registered nurses (RNs) who practice in settings outside the hospital, also known as ambulatory care.

"The traditional outpatient model of single physicians in their own office is disappearing," said Margaret Fisk Mastal, PhD, RN, lead author of the paper. "Today, patients’ needs are much more complicated, and their care is provided by a team of health care providers, not just a single doctor in an office."

With a team approach, coordination of care is essential, Mastal said. RNs are the providers most qualified to handle that job "because of their professional skills with patient-nurse relationships, their knowledge of health systems, and their collegiality with other health professionals."

Ambulatory care RNs work in a wide variety of outpatient settings, from the community to physician group practices to telehealth call centers. Their roles include nurse managers and administrators; staff nurses, educators, consultants, nurse practitioners and researchers. They are highly trained and are respected as leaders and innovators in the health care industry. Ambulatory settings employ 25% of the RNs in the U.S., according to the U.S. Department of Health and Human Services (DHHS).

The paper, "The Role of the Registered Nurse in Ambulatory Care," was published in the July-August 2012 issue of Nursing Economic$ journal. It outlines the evolution of ambulatory care environments thanks to advancing technology and changes in U.S. health care policy; changes in the scope of practice for ambulatory care nurses (including telehealth and organizational leadership); the growing complexity of patient needs; and recommendations for the future.

According to Mastal, not only have patients’ needs become more complex, many more of them are getting care in outpatient settings. Recent reports showed an estimated 994.3 million outpatient visits to physician offices in 2007, up from 906 million in 2003, she said.

This increased demand has led to growing numbers of ambulatory care RNs, and consequently a need for a clear definition of what role those nurses play in patient care.

Recognizing the need for a clear role definition across the industry, AAACN released an official position statement in February. The statement represents the work of a task force that was followed by the group’s intensive research to develop the more detailed position paper.

"Today’s emphasis on quality and safety has produced a critical need for more RNs in ambulatory care," Mastal said. "The position paper advocates for registered nurses in our specialty because of their advancing knowledge and skills that will help ensure safe, quality care for patients and reduce unnecessary hospitalizations."

The position statement and paper are key documents to be referenced by nursing and health care professionals, consumers, regulatory agencies, and federal, state, and local governments. They will help steer the ambulatory care nursing specialty as care delivery continues to evolve in outpatient settings.

About the American Academy of Ambulatory Care Nursing
The American Academy of Ambulatory Care Nursing (AAACN) is a welcoming, unifying community for registered nurses in all ambulatory care settings. As the premier nursing organization for this specialty, AAACN is devoted to advancing the art and science of ambulatory care nursing. For more information, about AAACN, visit the AAACN Website; call: 1-800-AMB-NURS (6877); fax: 856-589-7463, or email us at