The shift from inhospital to ambulatory care is largely driven by managed care demands that healthcare be provided in the least costly manner. “Less invasive diagnostic and surgical procedures, plus shorter acting anesthetics have also contributed to the increase in ambulatory care,” says Barbara Cordell, RN, MSN, director of ambulatory operations for the University of South Florida Physicians Group.

The fast-growing field of ambulatory care nursing is fertile with nursing opportunities. Does ambulatory care nursing fit into your future?

A Diverse and Different Practice

One of the most striking features of ambulatory care is its diversity. Practice settings include surgicenters, immediate and urgent care, pediatric services, and networks of physician office practices, as well as community-based settings such as schools, workplaces, and homes.

For nurses who want to switch from inpatient acute care to ambulatory care, it’s important to know that the two areas of practice are very different. “Compared with inpatient care, ambulatory care is a high-volume, fast-paced service, with limited appointment time,” says Peg Mastal, RN, PhD, president of the American Academy of Ambulatory Care Nursing (AAACN).

Triaging patients, coordinating care, providing direct nursing clinical services, and teaching patients about disease prevention and health maintenance within a compressed time frame presents a unique challenge.

Mastal identifies several characteristics of ambulatory care nursing: rapid, skillful assessment; a shift in the locus of control; high nursing autonomy; ambiguity of practice; and a high level of collaboration with other healthcare professionals.

“In the ambulatory care environment, the knowledge and experience of nurses are vital,” Mastal explains, “because nurses need to assess and triage very quickly.” This rapid assessment often occurs without the wealth of data available to inpatient-based nurses. In an urgent care center, for example, the nurse has no medical record, no history, no labs. “In ambulatory care, you cannot accumulate the same data as in inpatient settings,” Mastal says. And when nursing tools and ways of defining care must be condensed, she adds, nursing judgment is critical. For this reason, Mastal views ambulatory care primarily as a practice setting for experienced nurses. “Nurses with ICU or ED experience do very well,” she says.

However, Cordell does not entirely rule out new graduate nurses as potential candidates for positions in some ambulatory settings. “Each ambulatory care setting determines what skills are needed,” she says. New graduates with some prior physician office experience may do well in this setting, while highly specialized settings such as outpatient surgicenters and outpatient oncology centers, where chemotherapy infusions are given, require nurses with specialized skills and experience.

More than anything, Cordell says, a nurse must like this type of care. “You must enjoy the role of coordinating, of keeping the flow going, and recognize that care is scheduled and must be delivered on time,” she says. There is constant prioritizing that must take place within most ambulatory care settings. She cautions that this specialty may not be for nurses who prefer a more prolonged patient interaction and have the need to develop a deeper relationship with each patient. “The rewards are similar to other areas of nursing, but the delivery of care is very different,” Cordell adds.

Elaine Fidler, RN, MSN, nurse manager of the surgical procedure and postanesthesia units at St. Mary’s Hospital in Langhorne, PA, views a high degree of flexibility as one of the key ingredients to success in ambulatory care. “In any given day, procedures may range from pediatric or gynecological to orthopedic or endoscopic.” As services continue to increase, she adds, nurses also need to be ready and open to learn new procedures.

Unlimited Career Opportunities

As ambulatory care increases in scope, so do the career opportunities for RNs. One of the advantages is a more traditional Monday through Friday daytime schedule; however, those who work in some ambulatory care areas caution that there are some exceptions to this rule. On-call may also be required in some areas.

Salaries are competitive with hospital salaries. “Essentially, ambulatory care settings are competing with acute care to recruit and retain nurses – especially in areas with great need,” Mastel says. Some of these areas of demand include adult and pediatric critical care and emergency care.

If ambulatory care sounds like it meets your career needs, the American Academy of Ambulatory Care Nursing (AAACN) can give you more information regarding opportunities in this fast-growing field. You can reach them online at http://aaacn.inurse.com or by phone at (800) AMB-NURS.