What's it like to be an ambulatory care nurse?

  1. What are some of the things you like best or that you hate the most about ambulatory care nursing?
    What's the biggest stressors, and what are the doctors like to work with, compared to acute care hospitals?
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  2. 25 Comments

  3. by   nur.bmb
    This is my first post after being a BB lurker for only 1 week.
    Great place to share. I am an RN with 24 yrs. experience, the last 14 in outpatient dept.
    My experience in outpatient/ambulatory nursing has been a career saver! The doctor's are usually more easy going in our clinic than when they are on the inpatient units. Even the real PAINS (we all know them) are different in the outpatient setting.
    We schedule all the specialty clinics for adults and peds and take care of the pre-post procedure patients for Arteriograms/myelograms/CT guided biopsies, etc. We are also the Out Patient Oncology Unit for Chemo and Bone Marrow Bx. We do not care for the GI scope pts. or the Same Day Surgery pts.
    We have found that the physicians learn quickly they can trust us and if we call them, it's for something important.
    We (the staff) are blessed in that we have all been in nursing for about one hundred years so the level of confidence and competancy is high.

    Thanks for allowing me diarrhea of the mouth!
  4. by   tracib
    I have been working in Ambulatory Care settings for the last 10 years. I know what you mean by "career saving". I was so tired of working on call (in the OR), all the weekends and holidays, I knew something had to give.

    I now work in a small rural hospital. Our Ambulatory Care Unit is a combination of pre-admission testing and teaching, pre-op admissions and post -op discharges, phase II recovery as well as outpatient medical treatments (dressing changes, wound care), outpatient chemo, outpatient blood administration AND we run an endoscopy lab, which runs anything from 3-12 cases per day, done under conscious sedation.

    It's a very busy, varied place to work. On any given day, I find myself doing some or all of the above....and I do enjoy it. The only downside is that we take PACU call after hours and on the weekends. So I still have to take call, but not as often as in the OR.

    I am also writing a new orientation program for nurses in our unit.

    My last job in Ambulatory care was in a major metropolitan area in a unit that was strictly segrgated into pre-op, intra-op, and discharge areas. We had our own 8 OR's and a full PACU. No call, but LOOOOONG hours.

    It's still one of the better jobs hospital based nursing has to offer.
  5. by   Goofball
    Do you have very many Code Blue events there,
    especially with doing conscious sedation?
  6. by   tracib
    No, we haven't had any code blues doing conscious sedation. We are specially certified to do the sedation. It entails several hours of classes and observation. The classes are taught by one or more anesthetists. If anything, I would think that we err on the side of caution giving drugs for sedation.

    We are also all certified in ACLS and PALS.
    Last edit by tracib on Feb 21, '02
  7. by   crazedredhead
    Originally posted by Goofball
    Do you have very many Code Blue events there,
    especially with doing conscious sedation?
    In our facility, we have only had one code blue, and it was a family member, not a patient. Most of our clients are ASA 1s or2s, so the risk element is much lower than it was in the hospital. JCAHO's latest "buzz" word is now "moderate sedation". Funny, how no matter how well you know your subject matter, they change the lingo, since there isn't that much new stuff!
  8. by   crazedredhead
    Originally posted by tracib
    I have been working in Ambulatory Care settings for the last 10 years. I know what you mean by "career saving". I was so tired of working on call (in the OR), all the weekends and holidays, I knew something had to give.

    I now work in a small rural hospital. Our Ambulatory Care Unit is a combination of pre-admission testing and teaching, pre-op admissions and post -op discharges, phase II recovery as well as outpatient medical treatments (dressing changes, wound care), outpatient chemo, outpatient blood administration AND we run an endoscopy lab, which runs anything from 3-12 cases per day, done under conscious sedation.

    It's a very busy, varied place to work. On any given day, I find myself doing some or all of the above....and I do enjoy it. The only downside is that we take PACU call after hours and on the weekends. So I still have to take call, but not as often as in the OR.

    I am also writing a new orientation program for nurses in our unit.

    My last job in Ambulatory care was in a major metropolitan area in a unit that was strictly segrgated into pre-op, intra-op, and discharge areas. We had our own 8 OR's and a full PACU. No call, but LOOOOONG hours.

    It's still one of the better jobs hospital based nursing has to offer.
  9. by   crazedredhead
    AMEN! If it weren't for ambulatory surgery, I would be asking people if they would like fries with that...I come from a 600 bed hospita where I worked PACU. I took a lot of call, and many nights we were CCU and ER overflow. ASU is a lifesaver.
  10. by   nurseratchett29
    I recently "crossed over" into ambulatory care. I can definately relate with crazedredhead in that after 7 years of working weekends, holidays (and often being mandated on holidays) i made the concious decision to never again work a w/e or holiday. I did pediatric homecare for 2 years and loved it but because of the lack of benefits that goes along with that I decided to give abulatory care a try. So far I love it!!!The docs treat me like a colleague rather than an "underling". They depend on me for a lot of support and I actually have the time to talk to them and to my patients. This change has been a positive one for me.
  11. by   Brownms46
    I worked in a GI specialty unit at a hospital in Seattle, and what was supposed to be a 2 week assignment ...turned into 6 months. All in all it was a great experience....but it was very stressful. I worked in the RR and the procedures done were EGDs, Colons, ERCP, Sigmoids, and the nurses from GI also covered Pulmonary for Bronchs....with all but the sigmoids done under conscious sedation. We started out with 30min turn arounds...with was cut down to 20min...and had very limited space...with 14 -18 cases a day....and this is where the stress came in. Along with the constant ringing of the phone...and pts...who showed up without doing their prep...or without a driver to take them home...or just plain late!!!!

    I made some life long friends there....I will always remember my time there fondly.... The staff however...did have to take call for a week at a time...BUT there was no holidays...except for emergencies. The hours were 8:30am - 1730 ...M-F...with (2) 15 min breaks...and an hour for lunch! Our CN made sure everyone got their breaks...and there was an excellent expresso stand...right around the corner in the hospital...and plenty of good food in walking distance.

    The docs were called by their first names...and were very laid back!! One of the best assignments I have ever had! I was offered a chance to stay...and now I wish I had! But hindsight is 20/20.
    Last edit by Brownms46 on Apr 30, '02
  12. by   BRobison
    HI group.
    I've just read through the posts on amb care nursing, and I'm glad to see the subject of concsious sedation come up.
    I'd appreciate an of you discussing what, primarily, makes up "conscious" sedation in your facility.
    What kinds of classes did you take to "qualify" for doing this?
    Did your facility qualify you, or your state board of nursing?
    Do the physicians actually tell you how much and what and when to give, or do you independently make those decisions?
    Or do you just have standing orders....?
    Do you use propofol?
    Thanks.............!
  13. by   Goofball
    We have actually been doing conscious sedation for years (they changed it to light, moderate, or deep sedation for the lingo. You play the game and never ever say you did deep sedation). Then we suddenly had to go to a 4-hour lecture to 'certify' us. And now we have official forms to fill out during the procedure, and one RN must do nothing but monitor the pt. and record vs and neuro status/ level of sedation q 5 min. - and the other RN give drugs. But we never have any support, can't get another RN or charge nurse never available. So it is not uncommon that the doc has the nurse assisting with the procedure while that same nurse gives drugs and monitors too.

    In ICU, we almost always use propofol for these procedures, and we do have airway and suction equipment and intubation tray in the room.
    Sidenote:
    My husband was an outpt. and had conscious sedation with fentanyl and versed, and he coded.
    Ended up in CICU. By the records, it looks like they drugged him up with some hefty doses, then didn't check his BP for 20 minutes. The naughty ambulatory nurse charted (obviously ahead) on the back of that same form, that he left and went home on room air after the procedure, and verbalized understanding of discharge instructions! She must have forgotten to change it in all the chaos of the code!
  14. by   BRobison
    WOW. That scenario with your spouse is unbelievable!!!
    It seems to be getting to be the standard of practice to have the "sedating" nurse by responsible for nothing else at all....and with good reason. The line between "concsious sedation" and "general anesthesia" can be crossed fairly quickly, and you need to be watching....(or being watched, as the case may be). I personally would refuse to do the job if I was expected to be responsible for "other" stuff, too.
    I hope things turned out ok after your horrible experience.........
    thanks for your reply

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