Ambulatory Care Nursing

[tnbutterfly - Mary, BSN]

Ambulatory Care Nurses care for individuals, families, and groups in a variety of settings outside the hospital. Ambulatory care nursing is a nursing specialty with its own professional society, standards of practice, certification, performance measurement criteria, and body of literature for evidence-based practice.

With patients living longer with chronic diseases, complications, and comorbidities, patient care is shifting to the outpatient setting, bringing sicker patients into the ambulatory care arena. Hospital stays are shorter today with follow up care being handled in ambulatory care settings. The need for more and better prepared RNs has never been greater. As a result of these changes, RNs have more opportunities for a variety of roles in a broad array of settings.

Work Environment

Ambulatory nurses work in a variety of settings: primary care and specialty outpatient clinics, call centers, physicians' offices, community centers, freestanding health clinics, nurse-managed clinics, ambulatory surgery centers, patients' homes, and telehealth service environments. The responsibilities, working environment, resources, and degree of independence vary considerably between these different ambulatory settings.

Skills and Responsibilities

Although ambulatory nursing can involve direct patient care, an ambulatory care nurse is often more the organizer and manager of care rather than the direct provider of care. This type of working environment requires a strong clinical background, leadership skills, and autonomous critical thinking ability that is very different from that employed in acute care. Ambulatory nurses interact with patients not only face to face but over the telephone and computer as well. In the absence of direct sensory input, very different assessment and communication skills are needed.

Education Requirements

In the past, Ambulatory care nurses were required to be Registered Nurses with a minimum of two years' experience working as an RN. Although that still may be preferred in some settings, many nurses are able to obtain positions in an ambulatory care setting with less experience. In fact, some settings will even consider new grads.

Although there is no additional training required, certification is available, and is preferred in most states.

Criteria for certification is as follows:

• Hold a current, active RN license within a state or territory of the United States or the professional, legally recognized equivalent in another country.
  
• Have practiced the equivalent of 2 years full-time as a registered nurse.
  
• Have a minimum of 2,000 hours of clinical practice in ambulatory care and/or telehealth nursing within the last 3 years.
  
• Have completed 30 hours of continuing education in ambulatory care and/or telehealth nursing within the last 3 years
  

Job Outlook

As a result of the Affordable Care Act (ACA) which ensures access to health insurance for millions of Americans who are currently uninsured, it is anticipated that these newly insured people will flood the healthcare system, particularly ambulatory care settings. Additionally the Affordable Care Act's emphasis on primary care and prevention will increase patient volume in existing primary care practices. Nurses will be needed for new roles in the ambulatory setting such as care coordination, chronic disease management, and telehealth.

With the development of these new roles in healthcare and the increase in procedural care occurring outside the hospital in settings such as infusion centers and ambulatory surgery centers, opportunities for RNs in ambulatory care will continue to increase. Many of the more traditional ambulatory settings such as primary care are beginning to hire more RNs in preference to medical assistants.We have already seen a downward trend in hospital hiring. Nurses seeking jobs will increasingly look to ambulatory care settings as a viable option for employment.

According to the Bureau of Labor Statistics, ambulatory care nursing jobs have a positive outlook. There will be a 22 percent growth in this field between 2011 and 2018. This is much faster than the national average of all other occupations. The increased demand will be due to a rising elderly population, and an emphasis on preemptive health care.

Salary

The median expected salary for an ambulatory care nurse in the United States is $61,464 based on data as of December 1, 2013 on salary.com. This figure will vary depending on where the job is located and the amount of previous experience the nurse has.

Organizations

American Academy of Ambulatory Care Nursing (AAACN)

Resources

American Nurses Credentialing Center

AAACN Viewpoint Newsletter CNE

---

You might like to read I am Afraid. Please Pray for Me; Munchausen by Internet: The Lying Disease that Preys on the Heart, and other articles in my blog Body, Mind, and Soul

[nursefrances, BSN, RN]

Thanks tntbutterfly for the wonderful and informative article. :)

I enjoy working in this field as a pre-op/post-op Nurse in an ambulatory surgery center.

[jead1]

Thanks tntbutterfly for the wonderful and informative article. :)

I enjoy working in this field as a pre-op/post-op Nurse in an ambulatory surgery center.

Nursefrances, do you mind telling me about ambulatory nursing? Is it the same as clinic nursing?

[pfchang]

Ambulatory nursing is explained briefly in the article at the top of the page. There are many different areas of ambulatory nursing explained in the paragraph called Work Environment. Maybe I am missing something? Maybe You could search in Allnurses or google specific ambulatory nursing areas if you have questions to get a foundation of knowledge.

[jead1]

Ambulatory nursing is explained briefly in the article at the top of the page. There are many different areas of ambulatory nursing explained in the paragraph called Work Environment. Maybe I am missing something? Maybe You could search in Allnurses or google specific ambulatory nursing areas if you have questions to get a foundation of knowledge.

Yes, I have read the article and searched this site but I would like to ask my own personal questions and get an actual nurse's point of view. Especially one who has experience in ambulatory nursing. I have specific questions like is the pay the same as hospital nurses? How's the work environment in relation to the doctors, staff, etc? Do you recommend a new grad working in ambulatory nursing straight outta school or does it require experience? How's a typical day at work? Is it hectic? Lol I'm just really curious! Plus most of the forums I googled on this site aren't recent. Even though the specialty probably hasn't changed since 2006 or 09 lol I just want a fresh perspective. :)

ps. I love your name! :)

[SHGR, MSN, RN, CNS]

Yes, I have read the article and searched this site but I would like to ask my own personal questions and get an actual nurse's point of view. Especially one who has experience in ambulatory nursing. I have specific questions like is the pay the same as hospital nurses? How's the work environment in relation to the doctors, staff, etc? Do you recommend a new grad working in ambulatory nursing straight outta school or does it require experience? How's a typical day at work? Is it hectic? Lol I'm just really curious! Plus most of the forums I googled on this site aren't recent. Even though the specialty probably hasn't changed since 2006 or 09 lol I just want a fresh perspective. :)

I'll take a stab at these.

I work in a primary care setting and it has changed completely since 2006/2009! LOL indeed! We use a proactive population-based model now (PCMH) rather than a reactive model. We had an EHR back then, but now we actually use it- communicating electronically with patients, running registries and dashboards, monitoring whether we are meeting outcomes for diabetes, HTN, screenings, etc.

No, we don't earn nearly what hospital nurses do (I took a several dollar per hour pay decrease when I transferred) but I love it.

I definitely would not recommend it for a new grad, unless he or she had worked as a medical assistant prior to becoming a nurse.

The rest of your questions are site-specific. Our docs are great; generally primary care docs are a good bunch, but YMMV.

[mclennan, BSN, RN]

The article is a little misleading. The criteria the OP listed to "be an Ambulatory Nurse" are actually the criteria required to sit for the ANCC certification exam. You do not necessarily need 2 years experience and 2000 hours just to work as an ambulatory nurse. Yes you need that to get CERTIFIED, but not all ambulatory nursing jobs require certification. It will depend on the company policy and the job description. Lots of clinic jobs (which is the majority of what ambulatory nursing is, in a nutshell) don't require ANCC certification, but I'm sure they'd love if you had it. I wish more places required the certification!

My first nursing job right out of school as a new grad was in a community clinic as a PHN. That was DEFINITELY ambulatory nursing. I didn't have experience or 2000 hours or certification. I did that for 4 years (working off a federal scholarship contract). Then worked in a clinic that was part of a major hospital chain for a year. Then I obtained my ANCC certification as an Ambulatory Nurse. Now I have been in ambulatory case management for a little over 2 years and have CCM certification. I am the only one in my current department with ANCC/CCM certification.

For me now, the pay equals that of hospital nurses. But I fought for and negotiated that pay. Once I had certification & experience, I had a little more power to ask for a decent pay rate. Starting out as a new grad in a clinic or outpatient center, it's best to take what is offered in terms of pay, especially these days. It will vary greatly depending on what part of the country you're in, what other certifications you have, the size of the company, etc. A little independent doctors office might not be able to afford to pay much, but might offer loads of important experience. A huge clinic chain or hospital might pay well but be a nightmare to work for. There is no definite pay range to tell you about, like any job in any profession, it will vary wildly based on many elements. If you are a new grad in nursing my advice it to take WHATEVER YOU CAN GET.

When I worked in clinics, patients had appointments booked all day. The MAs would check them in, verify insurance and put them in rooms. I'd come in and get vitals, do med recon, talk about why they were there that day and discuss history, any new symptoms/situations. Most patients were regulars who were there to manage chronic conditions like diabetes, CHF, COPD, etc. We knew them and their lives well. Depending on why they were there I'd listen to lungs, prep them for a Pap, confirm they were fasting, get a wound/rash area ready to be examined, etc. I'd record the info I collected in the chart and leave in the door pocket OR record on the EMR. Then the doc or NP would see them. They would issue orders for labs, treatments, meds, etc. I'd carry those out.....give shots, draw labs, do a urine dipstick, wound care, refer them to specialists, whatever was needed to help them manage their condition and keep them out of the hospital. Often I called patients and followed up, checking on them. Sometimes assisted with in-office procedures like debridement, colposcopy, infusions, etc. I also did TONS of patient education. Just teaching patients how to use a BP cuff or glucometer, how to use an Epipen or calibrate their insulin pump, took up a LOT of my time. AGAIN, this will vary. I'm just trying to give a basic idea of what amb nurses might do.

I moved into case management which is it's own specialty within a specialty. It is also ambulatory nursing but I spend most days on the phone, following up and talking with patients who have been recently hospitalized, gathering info, doing med recon, identifying needs and providing resources and referrals to get them the things they need to stay OUT of the hospital. If they tell me they are having a lot of nausea with a new med I'll alert their doc and they might call in a script for Zofran. I might hear a lot of chaos in the background and a family member might tell me the patient can't get out of bed & the meds are all wrong.....I might dispatch a social worker to the house. I make sure they have a ride to their follow up appts. and can get their meds. Sometimes I set up home health for them. I give them my # and our 24 hour line and they can call me with questions. I also fill in for the inpatient discharge nurse and do discharge planning, providing them info and education at the point of discharge.

All of these jobs, I worked 8-5, M-F. I also went to tons of meetings with docs and specialists, attended care conferences with families, collaborated with community agencies and home health, hospice and home infusion companies. I also became VERY proficient at utilization management (insurance authorizations, approvals and denials) and dealing with Medicare regs, state Medical programs and WIC.

I have a new opportunity on the horizon to do some case management program development for a community clinic soon, where I'll assist in creating a case management & preventative care program for a population based practice. I'll research demographics & stats, conduct interviews in the community to assess needs, study what works and what doesn't in other clinic systems, and make recommendations on how to create a program to follow and monitor high risk patients with chronic conditions. It's these folks who suck up the most money in health care, and we have to get a handle on them to keep them out of ERs and ICUs. I'll help implement some of the recommendations - hopefully collaboratively with other providers and allied professionals. Then I'll assess the implementation and evaluate what worked and what didn't. I will spend a lot of time in an office at a desk, but also lots of time out in the field & community. I'm excited and feel I've earned the opportunity to inform the development of programs like this!

So I hope that helps define a LITTLE of what ambulatory nursing is. Another amb nurse might have a TOTALLY different story and I hope those nurses will share!

[jead1]

I'll take a stab at these.

I work in a primary care setting and it has changed completely since 2006/2009! LOL indeed! We use a proactive population-based model now (PCMH) rather than a reactive model. We had an EHR back then, but now we actually use it- communicating electronically with patients, running registries and dashboards, monitoring whether we are meeting outcomes for diabetes, HTN, screenings, etc.

No, we don't earn nearly what hospital nurses do (I took a several dollar per hour pay decrease when I transferred) but I love it.

I definitely would not recommend it for a new grad, unless he or she had worked as a medical assistant prior to becoming a nurse.

The rest of your questions are site-specific. Our docs are great; generally primary care docs are a good bunch, but YMMV.

Thank you SHGR! I love nurses' experiences! So helpful!

[jead1]

The article is a little misleading. The criteria the OP listed to "be an Ambulatory Nurse" are actually the criteria required to sit for the ANCC certification exam. You do not necessarily need 2 years experience and 2000 hours just to work as an ambulatory nurse. Yes you need that to get CERTIFIED, but not all ambulatory nursing jobs require certification. It will depend on the company policy and the job description. Lots of clinic jobs (which is the majority of what ambulatory nursing is, in a nutshell) don't require ANCC certification, but I'm sure they'd love if you had it. I wish more places required the certification!

My first nursing job right out of school as a new grad was in a community clinic as a PHN. That was DEFINITELY ambulatory nursing. I didn't have experience or 2000 hours or certification. I did that for 4 years (working off a federal scholarship contract). Then worked in a clinic that was part of a major hospital chain for a year. Then I obtained my ANCC certification as an Ambulatory Nurse. Now I have been in ambulatory case management for a little over 2 years and have CCM certification. I am the only one in my current department with ANCC/CCM certification.

For me now, the pay equals that of hospital nurses. But I fought for and negotiated that pay. Once I had certification & experience, I had a little more power to ask for a decent pay rate. Starting out as a new grad in a clinic or outpatient center, it's best to take what is offered in terms of pay, especially these days. It will vary greatly depending on what part of the country you're in, what other certifications you have, the size of the company, etc. A little independent doctors office might not be able to afford to pay much, but might offer loads of important experience. A huge clinic chain or hospital might pay well but be a nightmare to work for. There is no definite pay range to tell you about, like any job in any profession, it will vary wildly based on many elements. If you are a new grad in nursing my advice it to take WHATEVER YOU CAN GET.

When I worked in clinics, patients had appointments booked all day. The MAs would check them in, verify insurance and put them in rooms. I'd come in and get vitals, do med recon, talk about why they were there that day and discuss history, any new symptoms/situations. Most patients were regulars who were there to manage chronic conditions like diabetes, CHF, COPD, etc. We knew them and their lives well. Depending on why they were there I'd listen to lungs, prep them for a Pap, confirm they were fasting, get a wound/rash area ready to be examined, etc. I'd record the info I collected in the chart and leave in the door pocket OR record on the EMR. Then the doc or NP would see them. They would issue orders for labs, treatments, meds, etc. I'd carry those out.....give shots, draw labs, do a urine dipstick, wound care, refer them to specialists, whatever was needed to help them manage their condition and keep them out of the hospital. Often I called patients and followed up, checking on them. Sometimes assisted with in-office procedures like debridement, colposcopy, infusions, etc. I also did TONS of patient education. Just teaching patients how to use a BP cuff or glucometer, how to use an Epipen or calibrate their insulin pump, took up a LOT of my time. AGAIN, this will vary. I'm just trying to give a basic idea of what amb nurses might do.

I moved into case management which is it's own specialty within a specialty. It is also ambulatory nursing but I spend most days on the phone, following up and talking with patients who have been recently hospitalized, gathering info, doing med recon, identifying needs and providing resources and referrals to get them the things they need to stay OUT of the hospital. If they tell me they are having a lot of nausea with a new med I'll alert their doc and they might call in a script for Zofran. I might hear a lot of chaos in the background and a family member might tell me the patient can't get out of bed & the meds are all wrong.....I might dispatch a social worker to the house. I make sure they have a ride to their follow up appts. and can get their meds. Sometimes I set up home health for them. I give them my # and our 24 hour line and they can call me with questions. I also fill in for the inpatient discharge nurse and do discharge planning, providing them info and education at the point of discharge.

All of these jobs, I worked 8-5, M-F. I also went to tons of meetings with docs and specialists, attended care conferences with families, collaborated with community agencies and home health, hospice and home infusion companies. I also became VERY proficient at utilization management (insurance authorizations, approvals and denials) and dealing with Medicare regs, state Medical programs and WIC.

I have a new opportunity on the horizon to do some case management program development for a community clinic soon, where I'll assist in creating a case management & preventative care program for a population based practice. I'll research demographics & stats, conduct interviews in the community to assess needs, study what works and what doesn't in other clinic systems, and make recommendations on how to create a program to follow and monitor high risk patients with chronic conditions. It's these folks who suck up the most money in health care, and we have to get a handle on them to keep them out of ERs and ICUs. I'll help implement some of the recommendations - hopefully collaboratively with other providers and allied professionals. Then I'll assess the implementation and evaluate what worked and what didn't. I will spend a lot of time in an office at a desk, but also lots of time out in the field & community. I'm excited and feel I've earned the opportunity to inform the development of programs like this!

So I hope that helps define a LITTLE of what ambulatory nursing is. Another amb nurse might have a TOTALLY different story and I hope those nurses will share!

Mclennan, this was SOOO informative!!!! Thank you! I knew that the article was a little strange in the beginning but I couldn't verify because I'm not a nurse lol. With your awesome experience...do you recommend a new grad fresh out of school to ambulatory nursing? Or do you think they should gain experience?

[mclennan, BSN, RN]

Lol new grad, you make it sound like you will have a CHOICE! Take whatever job you can get. I seriously doubt you'll have the luxury of choice.

I have never bought into the idea that every nurse needs that year or 2 of med/surg. I didn't, until about 2 years in, I got a weekend gig at a small hospital on an Ortho floor for about 6 months. I think it can't hurt, but again, use your brains......new grads are finding med/surg jobs at hospitals and I'm sure you'd do fine at a clinic.

[mclennan, BSN, RN]

I meant to say new grads are NOT finding jobs at hospitals......noticed it after the edit window closed!

[So.very.blessed]

Thanks tnbutterfly and mclennan. I am definitely not a new grad (30 + years), the majority in different ambulatory care settings. Because of moving twice to new communities in the last 1 1/2 years, I am not currently working.

Today I received the nurse.com Intensive CE Series course for Ambulatory Care Nursing Certification Review this April. Yes it's expensive, but I would like to gain the knowledge as I start my search for employment. Another issue is we are living in a small community (10,000 people) in northern Michigan (Cadillac) so I don't even know the healthcare community and options. I have also over the last few years been interested in Case Management, but those opportunities have never been available.

Do you think this course would be of benefit to me? Does anyone know anything about these Intensive CE series courses?

Thanks in advance!

So.very.blessed