Use nurses as keys to connect the dots in better health care

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The American Nurses Association recently released a statement urging the U.S. Congress to “listen to nurses when considering the best way to move forward on transforming America’s healthcare system.”  

As the days wind down for open enrollment in health-care options for 2018, we can see the brokenness of our health-care system is many layers thick. As a nurse for 17 years, I see it nearly every day.

{mosads}The Commonwealth Fund recently published a report ranking the U.S. last on overall performance, access to care, equity of care, efficiency and quality outcomes in comparison to other industrialized countries.


Several national organizations recently wrote a joint letter to legislative officials urging them to maintain the individual mandate of insurance coverage proposed in the Patient Protection and Affordable Care Act of 2008.  

Nurses in ambulatory, outpatient or community settings across the country are feeling this reality of decreased insurance coverage daily.  

The nursing profession, reported as the most trusted profession 15 years in a row, according to Gallup, is focused on the holistic plan of care for patients. Nurses work and care for patients whether or not their patients are insured. Nurses care for every human, from every diverse setting possible, making care coordination, high quality outcomes and access to care a reality.

With volumes drastically shifting from the hospital setting to the ambulatory setting, there is already a looming shortage of nurses prepared to provide the services they are well-equipped to deploy.

Many understand the role of the nurse in the hospital setting. But many more may not know whether or not a nurse or someone else is seeing them when visiting a primary care office several hundred times over the course of their lifetimes.

More need to understand the importance a nurse brings to this setting in connecting the dots of a care plan, finding resources, assisting with safety mechanisms in the home environment, educating to independent health , helping to identify factors such as lack of food or transportation and ensuring that the patient’s health improves.

I have seen this as a nurse and as a family member. Since June, two close family members have been in multiple patient care ambulatory appointments and tests. At times it has taken up to three weeks to receive a phone call with results or the answer to a question about a looming symptom of pain or discomfort.  

Tests are scheduled, only to have my family members show up for the test and sent home, with the test rescheduled due to improper notice on preparation. One family member used the emergency room twice in five months due to his pain level.

The Institute of Medicine recently called out the critical imperative for nurses to step forward and be utilized at top of scope, offering all that they have been prepared to do in their discipline to improve health care.  

Equity, access, coordination, education, advocacy; these are core elements of the nursing profession. This is why strategic placement of nurses in key settings such as the ambulatory environment is so vital right now.

The American Academy of Ambulatory Care Nursing supported this need, stating, “Ambulatory care RNs are well-prepared to assume an expanded role in the design and delivery of high quality care, defying traditional boundaries, and working in redefined inter-professional relationships, expanded community partnership and non-traditional healthcare settings.”

Recently the AAACN and several other partner organizations, including the Collaborative Alliance for Nursing Outcomes, have been pilot testing several measures of nursing excellence, nurse staffing, care coordination, patient satisfaction related to nursing and virtual health in the ambulatory setting.

The American Nurses Credentialing Center’s Magnet Designation has also started to include in its requirements, many ambulatory nursing specific excellence indicators.

If we want to peel the layers of dysfunction back in our health-care system, we must also engage and empower nurses in the community and ambulatory settings to meet patients where they are. There nurses can be advocates, translators, educators and connectors as well as partners in a better healthcare system overall.

Rachel Start is the director of Ambulatory Nursing, Nursing Practice and Magnet Performance at Rush Oak Park Hospital. She is founder and chair of the Illinois Ambulatory Nurse Practice Consortium and is a Public Voices Fellow through The OpEd Project.

Tags Ambulatory care nursing American Nurses Association American Nurses Credentialing Center Community nursing Health care Medical-surgical nursing nurses Nursing credentials and certifications Personal life

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