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Ambulatory Care Nursing and Magnet® Designation Nursing Economic$ Perspectives in Ambulatory Care Advancing the Science of Nursing: Ambulatory Care Nursing and Magnet® Designation Rachel Start Rebecca Graystone As health care shifts from an acute, disease, and episodic-based model to one of health, community intervention, and continuum- focused interventions, the ambulatory care nurse is essential in this transformation and its success. Leveraging the ANCC Magnet® Model as a blueprint to improved patient outcomes and care of the nursing workforce can ensure that transformation is achieved. mbulatory care nursing is a specialty that Shifting Landscape: Ambulatory Nursing is emerging as uniquely capable of and Value-Based Health Care A meeting various challenges across the healthcare continuum (American Academy of Comorbidities, psychosocial needs, frailty, and Ambulatory Care Nursing [AAACN], 2017). As the social determinant factors, among other current healthcare delivery system navigates a complexities of patient care, create challenges for pandemic, the realities of the sobering poor seamless care coordination and health promotion outcomes, lack of access, and equitable care that (ANA, 2013; Freeman, 2006). Additionally, with were present before 2020 persist (Emanuel et al., health care’s focus shifting from a fee-for-service, 2020; Radley et al., 2020). The need for healthcare episodic, acute care approach to that of value, transformation and nursing’s role as leader within health, and efficiency across the patient’s lifespan that mandate is related to the growing volume of and continuum, volumes are also shifting from complex, chronically ill, vulnerable populations, inpatient to outpatient (American Hospital in addition to inefficiencies associated with Association, 2018; Berwick et al., 2008; Schneider coverage, transitions of care, and services offered et al., 2017). throughout the continuum (Haas et al., 2019; Leveraging the role of the ambulatory care Schneider et al., 2017). This current reality, along nurse, who often sees patients for many years, with the pandemic, underscores the need for serving in their communities, may increase the nursing, in every setting and role, to take a value of health care for patients across the leadership stance, growing its scientific continuum (Start et al., 2018; Start et al., 2020). In knowledge base to meet the dynamic needs of this setting, nursing practice has not traditionally the populations it serves (AAACN, 2017; Institute had support for structures or processes that of Medicine [IOM], 2010). Embracing and promote practice commensurate with their advancing the ambulatory care nurse’s role as this education and training (Start et al., 2016). It is transformation occurs may improve the nursing vital nursing embraces this value-based profession’s ability to meet the social contract it perspective, creating interventions and deepening shares with the public to improve and advance discipline-specific science that is responsive to the health (American Nurses Association [ANA], 2010; progressive focus on health rather than disease. Start et al., 2018). RNs must be prepared to articulate their contribution to value-based care for patients and populations alike (Brown et al., 2020; Haas et al., 2019; Start et al., 2020). 90 March/April 2021 | Volume 39 Number 2 Nursing Economic$ Nursing Community Response: Supportive nurse-sensitive measures through the National Strategies at a High Level Database of Nursing Quality Indicators. As a profession, nursing is given the power to ANCC Magnet Program Description of self-regulate, grow its own body of knowledge, Program and Ambulatory Requirements and govern its practice and practitioners. In response to this authority, the profession is The American Nurses Credentialing Center’s accountable for returning to society the (ANCC) Magnet Recognition Program® has been promotion of health in its many populations strongly linked to improvement of workforce and (ANA, 2010; Donabedian, 1976). Self-regulation patient outcomes through the integration of the and professional governance are realized through Magnet model as a vehicle for nursing excellence nurses who practice to the full extent of their (Barnes et al., 2016; Friese et al., 2015; Lal, 2020; license and education, fully supported and Stimpfel et al. 2016). The Magnet Recognition competent (Clavelle et al., 2016) to conduct Program was started due to a study conducted by “constant surveillance so that departure from an American Academy of Nursing taskforce on standards can be detected early and corrected” Nursing Practice in Hospitals that identified work (Donabedian, 1978, p. 836). The IOM (2010) environments that attracted and retained well- Future of Nursing report noted the nursing qualified nurses while also obtaining excellent profession, due to its “numbers and adaptive outcomes (ANCC, 2021). Forty-one organizations capacity was perfectly poised to bridge the gap that qualified for the original study were able to between coverage and access…to enable the full attract and retain well-qualified nurses amid a economic value of its contributions to be realized” national nursing shortage. Those organizations (p. 1). Further, AAACN, the specialty organization had common themes of structure, process, or for ambulatory care nurses, in their nursing outcome based on the current empirical Magnet position paper on the “Role of the Registered model clustered in five domains: Transformational Nurse in Ambulatory Care” stated, Leadership; Structural Empowerment; Exemplary Creating a future that maximizes the role Professional Practice; New Knowledge, of RNs in an evolving healthcare Innovations, & Improvements; and Empirical environment will require sustained Outcomes. These domains are surrounded by the momentum in nursing practice, education, dynamic and contemporary issues encompassing research, and leadership…to build the nursing and global health care (ANCC, 2017) (see science of ambulatory care nursing, Figure 1). As of December 2020, 548 (including clinical nurse researchers must be 12 international organizations) or about 8.5% of engaged in the development of new registered U.S. hospitals achieved Magnet knowledge and innovation to build the recognition and, as such, are known for evidence base needed to support excellence in outcomes within the five ambulatory care practice. (2017, p. 6) components (ANCC, 2020). From 2013 to 2019, the AAACN nurse- Magnet-designated organizations demonstrate sensitive indicator taskforce identified, developed, strong nursing professional governance, proposed, and pilot tested 15 measures to reflect collaboration, advocacy, research and innovations, the quality of care delivered by ambulatory care and patient and staff outcomes. Combined, these nurses (AAACN, 2017; Haas et al., 2019; Start et factors provide evidence of enculturated Magnet al., 2016; Start et al., 2018). A benchmarking principles across all settings where all levels of structure, where clinical sites could compare RNs practice. In 2019, the ANCC Commission on across specialty, volume size, organizational Magnet enacted a new set of standards, which service line, and system, was also developed more broadly emphasized ambulatory care (Start et al., 2018). These measures and adjoining nursing’s evolution into the recognition process benchmarking database are now a part of the (ANCC, 2017). Ambulatory care nurses must Press Ganey portfolio, which also offers inpatient continue to show evidence of the same structures March/April 2021 | Volume 39 Number 2 91 Nursing Economic$ Figure 1. Understanding the Magnet Model Source: American Nurses Credentialing Center. Used with Permission. All Rights Reserved. as other settings within the applicant organization, crosswalked to the resources available from practice oversight by the chief nursing officer AAACN are listed in Table 1. (CNO), and provide proof of outcomes related to As organizations have sought to meet ANCC nursing care delivery, workforce, and patient care. standards for Magnet recognition, several As ambulatory care nursing practice continues to strategies have emerged as key to integrating the shape and define care delivery, the Magnet Magnet model into nursing practice and the Recognition Program monitors growing evidence organization, in all settings, inclusive of and confers with experts in this specialty setting, ambulatory care. Contacting the Magnet Program including AAACN. Further, the Commission on Office (MPO) is the first strategic step to Magnet includes a member with ambulatory care understand the Magnet application and scope and nursing care expertise. breadth of the appraisal process, including AAACN, the specialty body of nurses who requirements to maintain the credential. Magnet work to advance nursing care in the ambulatory standards (Sources of Evidence), eligibility care setting, has supported the maximization of requirements, and the four phases (application, the role of RNs in the evolving healthcare written documentation, site visit, and decision) are environment via numerous strategies and tactics. foundational for leaders, stakeholders, and the Authoritative position statements, rigorous work organization at large to understand. Ambulatory to develop nurse-sensitive indicators, white care settings frequently have special data papers on telehealth and nurse transition to collection measures, geographic distance, and practice, and toolkits that support the growing matrixed reporting structures, whether in stand- role of the nurse executive in ambulatory
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