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Ambulatory Nursing Staff Roles and Responsibilities (2.02)

Ambulatory Nursing Staff Roles and Responsibilities (2.02) - Policies, Clinical, UWHC Clinical, Department Specific, Ambulatory, Staffing and Operations

2.02

2.02 Ambulatory Nursing Staff Roles and Responsibilities  
Category:  UWHC Departmental Policy   
Policy Number:  2.02    
Effective Date:  October 22, 2014   
Version:  Revision    
Manual:  Ambulatory    
Section:  Staffing and Operations (Ambulatory)   
 
 
I. PURPOSE

To define how all classifications of patient care nursing staff are assigned to appropriate responsibilities in clinics,
based on expertise, regulations and standards of care assuring that care, treatment, and services are provided to
the patient in an interdisciplinary, collaborative manner.

II. POLICY
A. Ambulatory care nurses function in a multidisciplinary, collaborative practice environment, where utilizing
critical thinking skills they interpret complex information relating to patient and family care, health and
well-being. (AAACN Registered Nurse Ambulatory Care Position Statement 2011)
B. Registered Nurses (RN) in ambulatory care possess strong clinical, education, leadership and advocacy
skills. They are uniquely qualified to manage complex care that is patient and family centered, ethical,
evidence-based, safe, expert, innovative, healing, compassionate, and accessible.
C. RN responsibilities: The following criteria are a few of the indications for RN assessment, planning,
intervention and evaluation:
1. Patient requires or requests teaching/support regarding:
a. Diagnosis of chronic or terminal illness
b. Illness/condition
c. Health promotion/maintenance (if standardized, may be delegated to Medical Assistant
[MA]/Student Nursing Assistant [SNA]/Licensed Practice Nurse [LPN]/Technician (Tech))
d. New medication/treatment
e. Complex self-care regimen or re-enforcement of current therapy
f. Symptom/side-effect management
g. Appliances/home care (if standardized, may be delegated to MA/LPN/ SNA/Tech
h. Pain management
i. Transitions of care
2. Patient has multiple psycho-social issues/concerns.
3. Patient/family requiring referral for social services, home health.
4. Patient does not demonstrate ability to care for self and/or family needs assistance in caring for
patient.
5. Patient/family is frequent caller, needs frequent reassurance and contact with health care
practitioner.
6. Patient requires or requests a RN's specialized expertise (e.g. wound care prevention of skin
problems, sexually transmitted diseases, suspected abuse).
7. Patient is undergoing sedation or procedure requiring physiological monitoring, recovery,
discharge assessment and instruction. Measurement of routine vital signs and other
measurements can be delegated to MA/LPN/SNA/Tech under RN supervision.
8. Hospital admissions requiring patient teaching, planning and coordination.
9. Triage (telephone or walk-in) of patients with symptoms, health questions or concerns.
10. Patient/family requests to see or speak with an RN.

11. RNs may function as the provider (RN only visits) for specific teaching assessment and follow-up
visits based on protocols or specific medical orders.
D. Interventions that RN may delegate to MA/LPN/SNA/Tech: The following interventions may as appropriate
be delegated to an MA/NA/LPN/Tech under the direction and supervision of an RN:
1. Clinical visit check-in: Escorting patients to rooms and performing the clinical check-in (taking
vital signs, weights, recording chief complaint, pain and learning assessment, medications and
allergies).
2. Routine follow-up (e.g. follow-up to a previous clinic appointment): MA/LPN/SNA/Tech collects
routine data as defined by previous visit to assist the provider in being prepared for the visit.
3. Assist with a procedure unless a patient situation deviates from the normal/routine circumstances
related to that procedure, in which case an RN may assist.
4. Routine vital signs and measurement of uncomplicated patients having conscious sedation post
procedure with RN immediately available.
5. Telephone calls not requiring symptom assessment or clinical decisions.
6. Fax, call in, or e-prescribe signed prescriptions after Physician approval or RN approval via
protocol.
7. Standardized Pre/Post procedure instruction (e.g. standardized teaching for MRI, colonoscopy and
operative procedures).
8. Administer medications to patient with instructions as needed on technique and medication. May
give oral and selected immunizations, skin tests, IM, and subcutaneous medications as ordered.
9. Perform selected procedures, after documented competency.
10. Visit checkout: Review plan for follow-up to assure patient understands plan and verify that
patient is satisfied upon checkout. Schedule diagnostic tests. Refer to RN if patient needs
further instruction. Review After Visit Summary (AVS).
11. Coordination of services (e.g. scheduling one or multiple appointments, arranging
transportation): A RN should be involved if the patient needs nursing referral to a community
agency or other professional, or if the nurse needs to share information related to patient’s
physiological or psychological condition in the process of coordinating services.

III. PROCEDURE

A. Nursing practice will be guided by the theory of Virginia Henderson who identified the unique role of the
professional nurses contribution to patient care and patients’ wishes to maintain independence.
B. Professional nurses in each clinic are responsible for providing safe, timely and fiscally responsible care by
adopting the primary nursing model.
C. It is an expectation that there is consistency in which RN and MA/LPN/SNA/Tech work with a
physician/patient to facilitate continuity of care, communication and collaborative practice.
D. See position description for additional role definitions of RN, MA, LPN, SNA or Tech.

IV. REFERENCES

Scope & Standards of Practice for Professional Ambulatory Care Nrsg, 2012
The role of the registered nurse in ambulatory care position statement, AAACN 2013
Joint Commission Standards, 2014
UWHC Professional Nursing Practice Philosophy of Nursing Practice, 2011
Nursing Administration Policy 1.19 - Scope of Service and Nursing Care

V. REVIEWED AND APPROVED BY

Ambulatory Policy and Procedure Committee
Clinics Administration

SIGNED BY

Karen Leimkuehler, RN, MS, Clinic Operations Director