Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

Postoperative Delirium Prevention in the Older Adult: An Evidence-Based Process Improvement Project.

Postoperative delirium is a major complication in hospitalized older adults. Implementation of a screening tool and evidence-based delirium-prevention protocol on a surgical unit increased nurses' knowledge regarding delirium, increased identification of delirium, and produced medical treatment alterations leading to positive patient outcomes.

Developing the value proposition for the role of the registered nurse in care coordination and transition nagement in ambulatory care settings.

The Patient Protection and Affordable Care Act (2010) established clear provisions for Patient-Centered Medical Homes and Accountable Care Organizations. In both, care coordination and transition management are methods to provide safe, high-quality care to at-risk populations such as patients with multiple chronic conditions. The emphasis on care coordination and transition management offers opportunities for nurses to work at their full potential as an integral part of the interprofessional team. Development of a model for the registered nurse in care coordination and transition management provides nurses the opportunity to develop the knowledge, skills, and attitudes to be a resource to the team and to patients, and to contribute to high-quality patient and organization outcomes.

Health care reform: current updates and future initiatives for ambulatory care nursing.

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.

Ambulatory care registered nurse performance measurement.

On March 1-2, 2010, a state-of-the-science invitational conference titled "Ambulatory Care Registered Nurse Performance Measurement" was held to focus on measuring quality at the RN provider level in ambulatory care. The conference was devoted to ambulatory care RN performance measurement and quality of health care. The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change. The objectives were achieved through presentations and discussion among expert inter-professional participants from nursing, public health, managed care, research, practice, and policy. Conference speakers identified priority areas for a unified practice, policy, and research agenda. Crucial elements of the strategic dialogue focused on issues and implications for nursing and inter-professional practice, quality, and pay-for-performance.

Priming the pipeline: creating aspirations for new graduate nurses to enter ambulatory care nursing roles.

The magnitude and projected length of the nursing shortage coupled with the increasing demand for ambulatory care nurses requires that novel strategies to attract and recruit new ambulatory care nurses be implemented. Planning and implementation strategies aimed at the current pool of student nurses are discussed in detail. Initiatives to elicit support of current ambulatory care nurses, deans, directors and faculty of schools of nursing are also presented along with options for evaluation of such initiatives.

Resourcing evidence-based practice in ambulatory care nursing.

Ambulatory care nurses may benefit from not only developing knowledge and skills in evidence-based practice (EBP), but also in identifying and providing sufficient resources for EBP to be implemented and sustained. Organizations should select one of the five conceptual models available in the literature to guide development and implementation of EBP. Costs of implementing and sustaining EBP include expert consultation, facilitators, staff time, informatician time, and data management. Benefits of EBP include improvements in patient care quality and safety, as well as regulatory compliance and risk management. Resources supporting EBP include professional literature available via the Internet and databases or agencies, such as ARHQ, professional organizations, and funding through grants.