U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Planning, Evaluation & Research

RRM Category: AMBULATORY CLINIC

RRM Module: Ambulatory Nursing

Overview
The RRM Ambulatory Nursing staffing module estimates the requirements for nurses that provide comprehensive health care and education to the individual and family in the ambulatory setting. The workload parameter that is the key variable in the staffing estimation for Ambulatory Care Facilities is Primary Care Patient Visits (PCPVs). For Out Patient Departments in hospitals supervisory and their clerical support is based on ambulatory clinics. This module estimates the need for Nurse Managers, Registered Nurses, Licensed Practical Nurses, and Clerical Support for ambulatory.

Services Description
Ambulatory Nursing provides comprehensive health care and education to the individual and family in the ambulatory setting, through provision of nursing care and/or services utilizing the nursing process, and in coordination with the medical plan of care and other health care providers. Continuity of care is accomplished through coordination of services with inpatient and community health programs and utilization of community resources in the promotion/maintenance of health.

Ambulatory Nursing services are directed towards meeting the needs of individuals, families, and the community during times of health and illness. Within the Indian Health Service, the ambulatory care nursing staff services people of all ages. Ambulatory care nurses apply their skills in, and knowledge of, clinical nursing, administration, public health, epidemiology, counseling, and education to provide direct and indirect services such as: therapeutic, emergency, health promotion, disease prevention, and advocacy services.

Staffing Criteria
1.00 FTE Nurse Supervisor for every ambulatory care clinic with a staff of at least 3.00 registered nurses and the clinic is located within a hospital.

1.00 FTE Medical Clerk for every ambulatory clinic with a staff of at least 3.00 registered nurses and the clinic is located with in a hospital.

1.00 FTE Nurse Manager for every 10,400 PCPVs up to 10,400 PCPVs, plus 1.00 FTE Nurse Manager for every 16,000 PCPVs above 10,400 PCPVs.

Fixed Registered Nurse staff of 1.43 FTEs for each facility with at least 4,400 PCPVs, plus 1.00 FTE Registered Nurse for every 3,200 PCPVs above 4,400 PCPVs.

Fixed 0.35 FTEs Licensed Practical Nurse for every facility with at least 4,400 PCPVs, plus 0.35 FTE Licensed Practical Nurse for every 3,200 PCPVs above 4,400 PCPVs.

Fixed 0.33 FTEs Clerical Support for every facility with at least 4,400 PCPVs, plus 0.33 FTEs Clerical Support for every 3,200 PCPVs above 4,400 PCPVs.

STAFFING FORMULAE

Personnel Categories:
Nurse Supervisor
Medical Clerk
Nurse Manager
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Clerical Support

Driving Variables:
Registered Nurse Staff
Facility Type
PCPVs

MINIMUM STAFFING LEVELS (fixed):

Personal Category FTEs
Registered Nurse 1.43
Licensed Practical Nurse 0.35
Clerical Support 0.33

Plus, VARIABLE STAFFING LEVELS:

Personal Category FTEs per Driving Variables Min. Max.
Nurse Supervisor 1.00 OPD Clinic Fac. Type/#RNs 1 n/a
Medical Clerk 1 OPD Clinic Fac. Type/#RNs 1 n/a
Nurse Manager 1.00 10,400 PCPVs 0 10,400
Nurse Manager 1.00 16,000 PCPVs 10,400 n/a
Registered Nurse 1.00 3,200 PCPVs 4,400 n/a
Licensed Practical Nurse 0.35 3,200 PCPVs 4,400 n/a
Clerical Support 0.33 3,200 PCPVs 4,400 n/a


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