Table of Contents Scope and Standards Revision Team . .2 Introduction . 5 Overview of the AAACN Standards 9th Edition . 5 Scope of Practice for Professional Ambulatory Care Nursing . 6 I. Definition of Professional Ambulatory Care Nursing . 6 II. Conceptual Framework . 7 III. Evolution of Modern Ambulatory Care and Nursing Practice . 9 IV. Practice Environment . of. 10 V. The Science and Art of Ambulatory Care Nursing Practice . 12 VI. Ambulatory Care Nursing Roles . .13 VII. Professional Trends and Issues . 14 Standards of Practice for Professional Ambulatory Care Nursing . 17 Standards of Professional Clinical Practice . .19 Standard 1: Assessment . 21 Standard 2: Diagnoses . 22 Standard 3: Outcomes Identification . Nursing. 23 Standard 4: Planning . 24 Standard 5: Implementation . 25 5a: Coordination of Care . 26 5b: Health Teaching and Health PromotionAcademy . 27 5c: Telehealth Services . 28 5d: Consultation . 29 Standard 6: Evaluation . Care. 30 Standards of Nursing Organizational and Professional Performance . 31 Standard 7: Ethics . .33 Standard 8: Education . 34 Standard 9: Research and Evidence-Based Practice . .35 Standard 10: Performance Improvement . 36 Standard 11: Communication . 37 Standard 12: Leadership . .38 Standard 13: Collaboration . 40 Standard 14: Professional Practice Evaluation . .41 StandardAmerican 15: Resource Utilization . .42 Standard 16: Environment . .43 © Glossary . 44 References . 46 AmbulatoryAdditional Readings . 47 Scope and Standards of Practice for Professional Ambulatory Care Nursing – 9th Edition – 2017 3 Introduction he American Academy of Ambulatory Care Overview of the AAACN Standards 9th TNursing (AAACN) is the specialty nursing organ- Edition ization for nurses practicing in ambulatory care set- In 1987, AAACN published the first edition of the tings. AAACN is responsible for establishing and standards. That document contained the landmark maintaining the standards for ambulatory care pro- standards for professional ambulatory care nursing fessional nursing practice. Ambulatory care is and administration. It outlined, for the first time, a defined as outpatient care in which individuals stay definition, philosophy, and standards reflecting the less than 24 hours in the health care environment unique ambulatory care nursing environment. and are then discharged to their residential situation Ambulatory care nursing is dynamic – changing following the care episode. and expanding to meet the health care needs of the populations served, along with the demandsof of insti- This publication is an updated scope of prac- tice statement and 16 revised standards for the clin- tutions delivering care. Inspired by the visions, val- ical and administrative professional practice of ues, and traditions of the past, these standards ambulatory care registered nurses (RNs). The stan- reflect current professional norms, practices, and dards promote effective clinical and administrative expectations. The standards recognize the evolving management of increasingly complex ambulatory landscape of professional practice by regular review care RN roles and responsibilities in a changing with needed revisions since 1987, ensuring useful- health care environment. ness, relevancy, accuracy, and measurable out- This publication maybe used to: comes. The standards are now in their 9th edition. 1. Provide guidance to outpatient care systems for This set of revisions represents the work of the the development of structure and processes in Scope and Standards of Practice for Professional the delivery of ambulatory care nursing (e.g., Nurses Task Force members who conducted a policies, procedures, role descriptions, and broad scope of activities from September 2015 to competencies). December 2016. The task Nursingforce members searched 2. Guide the delivery of quality nursing care for a broad base of literature for knowledge and evi- patients, populations, and communities. dence and consulted with nurses practicing in 3. Facilitate the development of professional nurs- diverse organizational settings. Recognized ambula- ing knowledge in ambulatory care. Academytory care nurse leaders provided additional input 4. Facilitate the evaluation of professional nursing through reviews and comments. performance as evidenced in performance The 9th edition of the Scope & Standards of appraisals, peer reviews, and reflective practice. Practice for Professional Ambulatory Care Nursing 5. Stimulate participation in research and evi- contains some significant revisions from previous dence-based practice. versions.Care 6. Guide performance improvement initiatives in In addition to the revised scope of practice, this clinical and organizational environments. publication contains 16 standards. The first six 7. Guide ethical practice and patient advocacy. address the phases of the nursing process; the last 8. Serve as a tool to advance ambulatory care pro- ten standards address professional performance. fessional nursing practice, patient health states, The depth and breadth to which ambulatory care and the performance outcomes of ambulatory RNs engage in the total scope of professional care health care institutions. ambulatory care nursing practice is dependent upon The scope of practice statement addresses the their education, experience, role, practice setting, definition and unique characteristics of ambulatory and the populations served (American Nurses care nursing, the conceptual framework, its history Association [ANA], 2015). over the past 30 years, the diverse types of ambula- Each standard contains three sections: tory care settings, the roles of ambulatory care RNs, 1. A statement of the standard addressed. the trends and issues in ambulatory care and future 2. Measurement criteria that may be used for directions.American The standards specify the competencies demonstrating competency for meeting the needed for professional clinical and administrative standard. practice. Together, the scope and the standards pro- 3. Additional standard statements and measure- © vide a structure for cataloguing and unifying the dis- ment criteria for nurse executives, administra- tinct nurse-patient interactions and organizational tors, and managers. activities that occur in diverse ambulatory care envi- These changes offer clarification and specificity ronments. for the distinct domains of clinical and administrative Ambulatory nursing practice in ambulatory care settings. Scope and Standards of Practice for Professional Ambulatory Care Nursing – 9th Edition – 2017 5 Scope of Practice for Professional Ambulatory Care Nursing he scope of practice statement describes the 3. Ambulatory care nursing occurs across the con- T“who,” “what,” “where,” “when,” “why,” and tinuum of care in a variety of settings, which “how” of professional ambulatory care nursing prac- include but are not limited to: tice. It offers a picture of the dynamism and com- • Hospital-based outpatient clinics/centers. plexity of nursing in outpatient settings and its evolv- • Solo or group medical practices. of ing boundaries (ANA, 2015). The scope of practice • Ambulatory surgery and diagnostic proce- initially defines the ambulatory care nursing special- dure centers. ty, its defining characteristics, and presents its con- • Telehealth service environments. ceptual framework. This document also reviews the • University and community hospital clinics. history of ambulatory care nursing, the events that • Military and Veterans Administration settings. changed its nature over time, the existing chal- • Nurse-managed clinics. • Managed care organizations. lenges, and the future possibilities. • Colleges and educational institutions. • Freestanding community facilities. I. Definition of Professional Ambulatory • Care coordination organizations. Care Nursing • Patients’ homes. Professional ambulatory care nursing is a com- 4. Ambulatory care RNs interact with patients dur- plex, multifaceted specialty that encompasses inde- ing face-to-face encounters or through a variety pendent and collaborative practice. The compre- of telecommunication strategies, often estab- hensive practice of ambulatory care nursing is one lishing long-term relationships.Nursing built upon a broad knowledge base of nursing and 5. Telehealth nursing is an integral component of health sciences, and applies clinical expertise root- professional ambulatory care nursing that uti- ed in the nursing process. RNs use evidence-based lizes a variety of telecommunications technolo- information across a variety of outpatient health care Academygies during encounters to assess, triage, pro- settings to achieve and ensure patient safety and vide nursing consultation, and perform follow up quality of care while improving patient outcomes and care coordination. (AAACN, 2011). 6. Ambulatory care RNs practicing in telehealth Ambulatory care includes those clinical, organi- environments adhere to the AAACN Scope and zational, and professional activities engaged in by Standards of Practice for Professional Telehealth RNs with and for individuals, groups, and popula- Care Nursing (AAACN, in press). tions who seek assistance with improving health 7. During each encounter, the ambulatory care RN and/or seek care for health-related problems. RNs focuses on patient safety and the quality of promote optimal wellness, participate in the man- nursing care by applying appropriate nursing agement of acute illness, assist the patient to man- interventions, such as identifying and clarifying age the effects of chronic disease