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Purpose
EXPLOSIVE CHANGES are occurring in the delivery of health services in ambulatory care settings. These changes, fueled by federal legislation, national reports about quality and safety, and consistently rising costs (Swan & Haas, 2011), challenge registered nurses to step forward and take a lead position in bringing health care reform to ambulatory care, also known as outpatient, environments (Institute of Medicine [IOM], 2011).
The American Academy of Ambulatory Care Nursing (AAACN) is the unifying professional organization for registered nurses in diverse types of ambulatory care settings. AAACN is committed to improving the quality of health care in outpatient settings, enhancing patient outcomes, and realizing greater health care efficiencies. The purpose of this paper is to articulate the essential role of the registered nurse (RN) in achieving these goals. RNs are critical to improving quality and safety and reducing costs in ambulatory health care systems.
Statement of AAACN's Position
It is the position of the American Academy of Ambulatory Care Nursing that:
* RNs enhance patient safety and the quality and effectiveness of care delivery and are thus essential and irreplaceable in the provision of patient care services in the ambulatory setting.
* RNs are responsible for the design, administration, and evaluation of professional nursing services within an organization in accordance with the framework established by state nurse practice acts, nursing scope of practice, and organizational standards of care.
* RNs provide the leadership necessary for collaboration and coordination of services, which includes defining the appropriate skill mix and delegation of tasks among licensed and unlicensed health care workers.
* RNs are fully accountable in all ambulatory care settings for all nursing services and associated patient outcomes provided under their direction (AAACN, 2011a).
These statements hold major significance for ambulatory health care systems and organizations; nurses and the nursing profession; health care professionals; consumers; regulatory agencies; and federal, state, and local governments. Registered nurses will partner with other health professionals to lead the transformation of American ambulatory care systems from a traditional medical model to a team-based system that advances a health care delivery model focused on preventing illness, disease, and unnecessary complications; promoting wellness; and eliminating unnecessary costs.
History of Health Services in Ambulatory Settings: Evolutionary Journey
Historically, in outpatient office settings, an individual...