Ambulatory Care Nursing is on the Rise

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Nursing and Social WorkThe fastest-growing sector of health care is ambulatory care, and as a result, many new and experienced nurses are pursuing careers in this area. Ambulatory care hiring increased by 24,300 jobs in November 2014, and average monthly job growth is up 26 percent for 2014, according to a report by Modern Healthcare.

Ambulatory care settings, which include physicians’ offices, laboratories and outpatient centers, employ 25 percent of the registered nurses in the U.S. and 33 percent of RNs with master’s or higher degrees, according to the American Academy of Ambulatory Care Nursing (AAACN).

A number of factors are contributing to the rapid growth in this area.

  • More Americans have access to health care because of the Affordable Care Act.
  • The aging population has more ailments, and in particular, chronic ailments.
  • Hospitals are downsizing services.

Some futurists predict one-third of all hospitals will close by 2020 as patients shift out of costly hospitals and into alternate settings such as ambulatory care. Only the most acutely ill patients will occupy hospital beds in the future.

In addition to filling existing roles in ambulatory care, nurses will be needed for newer roles such as care coordination, chronic disease management and telehealth.

Ambulatory care settings

The emphasis of ambulatory care nursing is on prevention and primary care. Ambulatory care settings are those where the patient is cared for on an outpatient basis, and do not stay overnight, as in a hospital or long-term care center.

Ambulatory care nurses are in different settings such as the following:

  • Clinics
  • Corporate workplaces
  • Dialysis centers
  • Doctor’s offices
  • Endoscopy/gastrointestinal labs
  • Home health care
  • Infusion centers
  • Medi-spas
  • Surgical centers
  • Telehealth
  • Urgent care
  • Wellness centers

Doctor’s offices can range from family medicine to a number of specialties such as cardiology, gastroenterology, endocrinology, obstetrics, ophthalmology and dermatology. Nurses in these settings assist doctors with patient consultations and procedures.

Telehealth is a relatively new specialty to nursing and is increasing in popularity because of advances in technology and the movement toward encouraging elderly people to live at home rather than at a senior care facility. Nurses in telehealth utilize a variety of technologies to triage, conduct consultations and deliver necessary follow-up on patient’s outcomes and status.

The corporate workplace is another emerging area for nursing as more large corporations bring clinics in-house. A 2013 National Business Group on Health survey found that 44 percent of employers (those with more than 5,000 employees) currently have on-site clinics. The most common services offered are related to occupational health, including diagnosis, simple treatment and referral for work-related injury and illness. Employers are increasingly offering a wider array of primary care services at these clinics, including preventive screenings, disease management and urgent care.

Ambulatory care nursing jobs

Hospital nurses aren’t the only care providers with intense jobs — ambulatory care nurses also have their share of excitement. Ambulatory nurses see a high volume of patients for brief periods. Nurses in this setting need to have sound clinical judgment skills to be able to make rapid assessments of patients in a time-constrained environment.

A large percentage of the patients in ambulatory care suffer from chronic diseases such as arthritis, asthma, cancer, COPD, diabetes, high blood pressure or kidney disease, and require a different type of care. Nurses rely on managing the disease by teaching and guiding the patient in self-care activities and helping patients making informed decisions about health behaviors. Family members are also frequently involved in this process.

How ambulatory care nursing differs from hospital nursing

Nursing in ambulatory care is vastly different from hospital nursing. In a typical hospital setting, nurses work on specific units with a large team of colleagues, including nurse managers, charge nurses and supervisors. Patients are seen continuously until they are well enough to be discharged or transferred, and the nurse-patient relationship ends when patients leave the hospital.

Ambulatory care nurses usually work in isolation as the only RN or with few other nurse colleagues, and often without a supervisor. Their relationships with patients are long term, lasting months or even years.

In hospitals, the plan of care is directed by the nurse with input from the family, but in ambulatory care, the reverse is true. The plan of care is directed by the patient and family members with input from the nurse.

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