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The Roles of Ambulatory Care Nurses During These Times and Beyond

Kathleen Martinez, MSN, RN, CPN

President, American Academy of Ambulatory Care Nursing (AAACN)

Ambulatory care nursing, or nursing given to individuals in an outpatient setting, has always been an essential component of medicine for children and adults alike.

For example, while less than 5 percent of children are hospitalized each year, 96 percent of them see a healthcare provider in an ambulatory setting, according to the Agency for Healthcare Research and Quality

“Our opportunity to influence health and healthy lifestyles is enormous,” said Kathleen Martinez, a registered nurse and the president of the American Academy of Ambulatory Care Nursing (AAACN). 

More than 80 percent of all cancer care  — including preparation for bone marrow transplants, radiation therapy, and high-dose chemotherapy — is performed in an ambulatory setting, Martinez explained. At the same time, the Center for Medicare and Medicaid Services estimates 70 percent of all surgeries, from bronchoscopies to endoscopies and dermatologic procedures, happen in an ambulatory setting. 

“In all of these settings, RNs use the nursing process to provide care, education, and support,” Martinez said.


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Ambulatory care at the start of COVID

The COVID-19 pandemic has strained healthcare providers across the world, and ambulatory care nurses in the United States are no exception. One unique challenge they faced involved lack of personal protective equipment, medical-grade face masks, and N95 respirators, especially at independent clinics, offices, and care centers, Martinez said.

Also, daily call volume increased by thousands at nurse-based telephone triage call centers, she said. And nurses had to assess ever-changing coronavirus guidelines and information, while determining whether patients needed urgent care. 

“Telephone triage is a complex skill where the nurse is required to assess a patient using only the phone,” Martinez said. “High volume, high acuity, and long hours combined with limited referral resources increased the strain on nurses during this time.”

Other challenges at the beginning of the pandemic included opening, staffing, and running COVID-19 testing centers in storefronts, as well as keeping individuals in homeless shelters safe under social distancing guidelines — two firsts for ambulatory care nurses, Martinez explained.

Continuing to face down COVID

When vaccinations became available in spring 2021, ambulatory care nurses helped organize vaccination campaigns, too. 

“These are things you do not learn in nursing school,” Martinez said.

The pandemic tested nurses in other ways. Martinez noted an estimated 5 percent of COVID cases required hospitalization, though final numbers from the U.S. Centers for Disease Control and Prevention (CDC) have yet to be determined. 

“A significant burden of this disease has fallen on ambulatory care, including caring for those persons hospitalized with severe disease who are now facing the challenges of rehabilitation.”

In recent years, Martinez said nursing has become viewed “as central to epidemiology, disaster preparedness, and response.” The pandemic illustrated just that.


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Eyeing the future of ambulatory care 

Through Martinez’s 30 years of experience in ambulatory care, she’s witnessed changes to the field, such as the passage of the Affordable Care Act in 2010, which she called “a game changer.” 

“After half a century of hospital-focused care, there was suddenly a shift to health maintenance, disease prevention, care coordination, patient-centered care, and looking at social determinants of health as a larger context of care,” Martinez explained.

Down the line, as people increasingly desire to receive care from home, telephone triage and telehealth visits may further change how ambulatory care nurses work, she said.

To aspiring ambulatory care nurses, Martinez emphasized that opportunities abound. “Care coordination, community outreach, advocacy, telehealth, patient wearables, epidemiology, infection prevention, mental health services, and racial disparities are all areas ripe for innovation,” she noted.

And to those already in the field, Martinez offered a message of inspiration: “It is no small thing to be invited into the home and life of another. That is our greatest privilege,” she said, “and when we respond with compassion and empathy, a sacred bond is created with our patients and families. Never doubt that your kindness can change a life.”

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