Isabelle didn’t say much, but you could easily see the kindness in her eyes. With her husband Jacob by her side, she let me thread the I.V. catheter into her vein so the I.V. fluids could help her symptoms improve. Jacob had called me earlier that morning, concerned for Isabelle. He told me she was becoming more and more fatigued and confused, and her generalized weakness was worsening. One liter of normal saline solution later, Isabelle seemed to perk up a little.

Less than 6 months later, she passed away in her own bed under hospice care. I’m glad I had the privilege of helping this sweet elderly couple as an ambulatory care nurse at a primary care family practice office. Discussing Isabelle’s symptoms over the phone with Jacob, giving her I.V. fluids during a visit to the physician’s office, teaching both of them about her newly discovered cancer, and coordinating her end-of-life care—all of this reinforced my love for my job.

Many registered nurses (RNs) avoid primary care settings. Even during my college and clinical rotations, I never heard my professors or colleagues discuss the role of the RN in primary care. Some nurses don’t even know this job opportunity exists. Others choose not to consider it because of their perception that primary care nursing isn’t “real” nursing. But after several years as an ambulatory care nurse in primary care, I have a better understanding of health care as a whole and feel more like a “real” nurse than I did before.

What it takes to succeed in primary care

Nurses in primary care settings must possess a variety of knowledge and skills. For instance, we need to:

• be able to prioritize tasks efficiently
• be able to assess patients over the phone without direct sensory input
• stay up-to-date on specialized clinical skills, such as administering I.V. therapy and childhood immunizations
• establish long-term relationships with patients while providing care across the life span
• act as an advocate for patients and their families
• use evidence-based resources to help teach and monitor patients
• serve as a care manager to coordinate services
• evaluate patient outcomes
• individualize care for each patient
• guide patients to make informed decisions about their care.

Daily responsibilities

As a primary care nurse, your day can be unpredict­able, requiring flexibility and the ability to handle a diverse workload. Tasks of an ambulatory care nurse may include telephone triage, nurse visits in the office, coordinating care, and supporting your team of providers.

Telephone triage

Telephone triage can be challenging because you can’t perform a visual assessment. To evaluate the patient properly, you need to know which questions to ask. For instance, many patients call their primary care provider to report symptoms they think might indicate a myocardial infarction or stroke; you’ll need to ask the right questions to know if they require emergency care. As a triage nurse, you must sort through all the information patients give you and determine the proper disposition for each patient—emergency-department visit, office visit, referral to another specialty, or home care.

Often, you become your patients’ main connection to the physician’s office as they learn to trust your judgment. You become their shoulder to lean on, even though you’re not there physically.

Nurse visits

Nurse visits put you face-to-face with patients. Administering immunizations keeps children and adults up-to-date on their vaccines. To manage hypertension, you check the patient’s blood pressure and review his or her medications. Teaching is crucial to helping patients understand their condition and manage their own care (such as patients with diabetes mellitus). Medication reconciliation helps your patients better understand what their prescriptions are for—and gives you an opportunity to make sure they’re taking them properly. Other specialized skills, such as administering I.V. therapy, add depth to clinic services and help keep your patients out of the hospital.

Care coordination

As an ambulatory care nurse, you serve as care coordinator for patients who’ve been discharged from the hospital. You’re expected to make a follow-up phone call within 24 or 48 hours after discharge. This phone call can be critical in preventing readmission by providing essential education to patients and family members and arranging teaching for required home care skills. You can also provide resources and referrals for transportation assistance, Meals on Wheels, or financial aid.

Teamwork and communication

Teamwork is crucial in any organization. Nurses in primary care must learn to support providers and nurse colleagues in providing the highest quality of care. Dealing with specialists outside the immediate clinic requires excellent communication skills to ensure continuity of care.

Interested?

Healthcare delivery is transitioning to increased ambulatory care with shorter hospital stays. Unlike inpatient care, which is a small blip in a patient’s life, primary care follows patients throughout their lifetime. In the United States, about 25% of RNs work in ambulatory care settings. With patients living longer with more complicated diagnoses, RNs are needed more than ever in the ambulatory care role.

A career in primary care as an ambulatory care nurse can be highly rewarding, offering a variety of patients and the ability to follow them completely throughout their healthcare trajectory. We are there for our patients throughout their lives, from providing preventive care to promoting best outcomes of acute and chronic health problems that arise.

For more information on ambulatory care nursing, visit the American Academy of Ambulatory Care Nursing website at www.aaacn.org. This organization offers specialized certifications, memberships, and practice and professional development resources.

References

American Academy of Ambulatory Care Nursing. American Academy of Ambulatory Care Nursing Position Statement: The role of the registered nurse in ambulatory care. Nurse Econ. 2011;29(2):96.

American Academy of Ambulatory Care Nursing. What is ambulatory care nursing? 2011. www.aaacn.org/what-ambulatory-care-nursing

Stokowski LA. Ambulatory care nursing: Yes, it’s a specialty. Medscape Nurses. September 26, 2011.

Amy Morissette is an ambulatory care nurse at Dartmouth-Hitchcock Hudson Family Practice in Hudson, New Hampshire. She is currently pursuing a master’s of science degree in nursing.