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									DACUM Chart for
Ambulatory Care RN

Susan Fresz
Shasta Community Health Center
Redding, CA

Carole Ferrari
Santa Barbara County Public      Produced by
Health Department
Santa Barbara, CA

Ruth Ann Obregon
Kaiser Permanente
El Cajon, CA

Catherine Crowley
Ojai Valley Community Hospital
Ojai, CA

Emma Tuskan
Kaiser Permanente                    California Community Colleges
La Mesa, CA                        Chancellor’s Office Regional Health
                                 Occupations Resource Centers/Health Care
Rita Hammond
Veteran’s Administration San                    Initiative
Diego Healthcare System
San Diego, CA

Marian M. Diangelo
San Francisco State University
San Francisco, CA

Nelda Malilay
Childhood Lead Poisoning
San Francisco, CA                              Date: November 13-14, 2003

DACUM Facilitators
Patricia Perkins
Regional Health Occupations
Resource Center
San Francisco, CA
DACUM CHART for Ambulatory RN                                                                           November 13-14, 2003
An Ambulatory Care RN is one who provides a holistic approach through the nursing process in a broad spectrum of patient care settings by
coordinating healthcare resources and services to support health outcomes and quality care.

   Duties                                                              Tasks
                                  A-1 Perform patient     A-2 Develop            A-3 Implement          A-4 Perform             A-5 Delegate or
A Provide
                                  assessment in           patient care plan      patient care plan      skilled nursing         oversee technical
  Direct/Episodic                 response to patient’s   specific to chief      specific to chief      procedures as           procedures
  Patient Care                    chief complaint         complaint              complaint              ordered or              performed by
                                                                                                        approved                ancillary staff
                                                                                                                                (C.N.A. & L.V.N.)
                                  A-6 Work under          A-7 Initiate and       A-8 Promote            A-9 Perform             A-10 Evaluate
                                  standing orders         provide emergency      preventive health      mandated health         pati3nt care plan
                                  and/or standardized     care as needed                                screenings              specific to chief
                                  procedures                                                                                    complaint
                                  independent of an
                                  M.D. Document
                                  direct care provided
                                  and patient response
                                  B-1 Utilize advanced    B-2 Assess             B-3 Follow             B-4 Refer to            B-5 Participate in
B Triage Non-                     verbal                  patient’s acuity       established policies   appropriate level       delivery of
     Scheduled Patients           communication skills                           and protocols for      of care                 emergency care
                                                                                 telephone triage and   (emergency,
                                                                                 non-scheduled lots     urgent, self-care)
                                  B-6 Educate patient     B-7 Manage clinic      B-8 Maintain access    B-9 Document
                                  on appropriate care     schedule to ensure     to healthcare          verbal
                                  per                     patients are seen in   information and        conversations and
                                  protocol/approved       an appropriate time    community resources    observations
                                  sources                 frame
                                  C-1 Assess/Reassess     C-2 Perform            C-3 Develop overall    C-4 Implement           C-5 Organize
C    Manage Patient
                                  patient eligibility     holistic patient       patient/care-giver     overall                 patient case load
     Health Care                                          assessment             care plan              patient/care-giver
                                                                                                        care plan

                                  C-6 Collect and         C-7 Advocate for       C-8 Refer patient to   C-9 Ensure              C-10 Initiate and
                                  Analyze patient data    patient                other services as      continuity of           coordinate patient
                                                                                 necessary              patient care            centered

                                  C-11 Identify ethical   C-12 Initiate ethics   C-13 Organize/tract    C-14 Evaluate           C-15 Maintain
                                  conflicts between       committee consult      multi-disciplinary     overall patient/care    required
                                  patient, family, and                           services               giver care plan         documentation

                                  D-1 Assess age          D-2 Develop            D-3 Implement          D-4 Educate             D-5 Teach self-
D Provide                         appropriate learning    patient education      patient education      patients’ on criteria   management skills
     Patient/Care Giver           skills                  plan                   plan                   that require
     Education                                                                                          medical evaluation

                                  D-6 Develop and         D-7 Educate            D-8 Evaluate           D-9 Document
                                  maintain patient        patients on access     effectiveness of       education provided
                                  education materials     to care                education

                                  E-1 Assess daily        E-2 Ensure             E-3 Manage clinical    E-4 Evaluate            E-5 Anticipate and
E                                 staffing needs          appropriate            flow                   patient flow            provide daily
     Coordinate Clinic
                                                          utilization of staff                          systems                 clinical provider
     Operations                                                                                                                 needs
DACUM CHART for Ambulatory RN                                                                            November 13-14, 2003
An Ambulatory Care RN is one who provides a holistic approach through the nursing process in a broad spectrum of patient care settings by
coordinating healthcare resources and services to support health outcomes and quality care.

       Duties                                                          Tasks
                                  E-6 Participate in the   E-7 Ensure            E-8 Develop and         E-9 Ensure            E-10 Ensure cost-
                                  development and          completeness of       maintain clinical       reimbursement for     effectiveness of
                                  implementation of        patient medical       standard operating      clinic visit          each visit
                                  protocols for            records (pre- and     procedures
                                  information flow         post visit)

                                  E-11 Ensure              E-12 Implement        E-13 Coordinate         E-14 Oversee          E-15 Maintain
                                  environmental health     disaster              research projects       equipment             inventory of
                                  and safety of patients   preparedness                                  acquisition and       medicine and
                                  and staff (i.e.          program                                       maintenance           supplies
                                  infection control)

                                  E-16 Identify and        E-17 Manage
                                  correct facility         sample
                                  problems                 medications

                                  F-1 Participate in       F-2 Orient new        F-3 Facilitate use of   F-4 Supervise         F-5 Assess
F                                 recruitment and          staff                 temporary staff         clinical staff        individual and
     Coordinate Health
                                  hiring process                                                                               overall team
     Care Team                                                                                                                 competencies

                                  F-6 Facilitate team      F-7 Facilitate        F-8 Facilitate inter-   F-9 Provide staff     F-10 Provide
                                  building                 conflict resolution   and intra-department    development           education and
                                                                                 communication                                 maintain clarity of
                                                                                                                               scope of practice
                                                                                                                               to all team

                                  F-11 Identify and        F-12 Initiate and     F-13 Contribute to      F-14 Advocate for     F-15 Participate in
                                  develop standardized     coordinate team       employee                team and              staff retention
                                  procedures to            conferences           performance             individual rewards    activities
                                  enhance the RN role                            evaluations             and recognition

                                  F-16 Train staff to
                                  operate new

                                  G-1 Respect patients’    G-2 Provide           G-3 Provide age-        G-4 Ensure access     G-5 Provide
G                                 rights                   culturally            appropriate care        to care (financial,   customized care to
     Promote Customer                                      competent core                                transportation,       meet individual
     Services                                                                                            etc.)                 needs

                                  G-6 Demonstrate          G-7 Acknowledge       G-8 Communicate         G-9 Utilize           G-10 Conduct
                                  positive professional    customer(s)’          changes that affect     conflict resolution   customer
                                  behavior                 expectation for       patient encounter       strategies            satisfaction
                                                           access and                                                          surveys
DACUM CHART for Ambulatory RN                                                                          November 13-14, 2003
An Ambulatory Care RN is one who provides a holistic approach through the nursing process in a broad spectrum of patient care settings by
coordinating healthcare resources and services to support health outcomes and quality care.

       Duties                                                         Tasks
                                  G-11Develop and
                                  implement customer
                                  service improvement

                                  H-1 Ensure              H-2 Ensure           H-3 Ensure age-         H-4 Adhere to all    H-5 Initiate all
H Ensure Quality                  individual privacy      cultural-competent   appropriate care        governing body       mandatory
     Care                         and confidentiality     care                                         regulations (DHS,    reporting
                                                                                                       HIPPA, JCAHO,

                                  H-6 Participate in      H-7 Participate in   H-8 Participate in      H-9 Participate in   H-10 Participate in
                                  documentation audits    writing policies     ongoing process         the development of   review of adverse
                                                          and procedures       improvements            standardized         outcomes (incident
                                                                                                       procedures           reports)

                                  H-11 Ensure             H-12 Ensure          H-13 Ensure disaster    H-14 Assess and      H-15 Participate in
                                  infection control       environmental        and emergency           report risk          quality assurance
                                  policies and            health and safety    preparedness policies   management issues    activities and
                                  procedures are          policies and         and procedures are                           committees
                                  followed                procedures are       followed

                                  H-16 Participate in
                                  clinical research

                                  I-1 Maintain            I-2 Stay current     I-3 Participate in      I-4 Adhere to        I-5 Precept staff
I    Maintain
                                  professional licenses   with new             annual skills           nursing and          and students
     Professional                 and certifications      technologies and     competency testing      organization’s
     Competencies                                         information                                  code of ethics

                                  I-6 Serve as role       I-7 Participate in   I-8 Incorporate         I-9 Enhance          I-10 Maintain
                                  model                   organizations and    evidence based          personal and         memberships in
                                                          community            nursing into practice   professional         professional
                                                          projects                                     growth               organizations
DACUM Chart for Ambulatory Care RN
Title:                                              Nursing Template Skills

        Ambulatory Care R.N.                             Assessment
        Clinic Nurse                                     History Taking
        Clinical Ambulatory Care R.N.                    Legal Issues
                                                          Documentation/ Protocols
Job:                                                      Dealing With Difficult Caller
        Assures Quality Care                             Ability to work with diverse populations
                                                           (patients and staff)
        Educate
        Manage Clinical Flow                             Financial and Budgeting
        Oversee Budget and Resources
                                                    Future Trends and Concerns
        Patient Care Manager
        Manage and Delivering Nursing Procedures         Population Based Health Education
                                                          Lack of Funding/Reimbursement
General Knowledge and Skills:                             HIPPA
                                                          Lack of Health Care Interpreters
        Community Resources
        Teach Thru Interpreter                           Evidence Based Practice
                                                          Increase Disease (TB, HIV, etc.)
        Critical Thinking Skills
                                                          Computers Increase Skill Level: Patient
        Chart Audits
        Scope of Practice
                                                          Sicker Patients (Standardized Procedures)
        HIPPA Regulations
                                                          Increase Use of Medications
        Risk Management
                                                          Bio-Terrorism
        Governing Body Regulations
                                                          Child Abuse
        Time Management
                                                          Medication and Medication Adherence
        Specialty Clinical Nursing Skills
        Communicational Skills
                                                          $?
        Organizational Skills
                                                          (Health Care Sector attempting to work with
        Conflict Resolution
                                                           lower pay and less trained workers)
        Stress Management
                                                          (Concern- Professional practice given to less
        Evidence Based Practice Knowledge                 qualified staff)
        Delegation                                       State of California Trends (esp. for elderly
        Mandated Reporting                                populations and low income families)
        Decision Making                                  Working Poor/Underinsured
        Emergency Response
        New Medicine
        Customer Service
DACUM Chart for Ambulatory Care RN
Work Behaviors                                             Dressing/Wound Materials
                                                           Gloves
      Patience                                            Weight Scale
      Flexible                                            Measuring Tape
      Honest/Respectful                                   “Girth”
      Professional/Ethical                                “Reverse our Flow Rooms”
      Patient Centered/Caring                             Telemedicine Equipment
      Trustworthy                                         Sigmond Equipment
      Work Ethic                                          Colonoscopy Equipment
      Hardworking-trying their best                       Leep Equipment
      Patient/Staff Advocate                              Blood Pressure Equipment
      Innovative/Open                                     Tracheotomy Equipment
      Sense Of Humor                                      Crash Cart/ Defibulator Equipment/AED (?)
      Motivated                                           Suction, Oxygen
      Willing to Learn                                    Emergency out of clinic “(Personal Protection
      Willing to Teach                                     Equipment)”
      Compassionate                                       Audiometer
      Take Responsibility for Actions/Accountability      Spints/crutches/cane
      Enjoy what they do                                  Peripheral Equipment: IV, hickman, portable
      Knowledgeable                                        catheter
      Able to work wit others                             Spirometer/nebulizers
      Team Leader/Team Member                             SaO2 Saturation
      Able to Problem Solve                               Tympanogram
      Wanting and doing more than is expected             Catherter
      Know boundaries                                     Suture/Staple Removal
      Conscientious                                       Cast Application and Removal Equipment
      Conflict Resolution                                 Ultrasound
                                                           (?) NST-Stress Test
Tools, Equipment, Supplies and Materials                   Pulmonary Equipment (Ultraviolet)
    Computer                                              Sterile Instruments
          o Word                                           Vision Charts
          o Email
                                                           I-Stat Machine
          o Patient Scheduling
                                                           (?) Hemoque
          o Electronic
          o Reports                                        Valley Lab-Cautery (Catherization?) Equipment
          o Intranet                                       (?) INR Machine-Coumahine Clinic
    Copy Machine                                          Proper handling of “Sharps”
    Pager system                                          Syringes
    Light system                                          Wheelchair
    Fax Machine                                           Medication Administration
    Printers                                              Lifts
    Multi-phone lines                                     Gurneys
    Stetescope                                            Split Lamps
    Glucometer                                            (?) Ergonomics
    Video Equipment                                       Procedure Chairs/Tables
    Laser Equipment                                       Surgical Lights
    Nasogastric Tube                                      Gowns/Chucks/Linens/Masks
    Otoscope                                              Podiatry Equipment
DACUM Chart for Ambulatory Care RN
Tools, Equipment, Supplies and Materials (cont’d.)
    Foot Sensory Filament
    Reference Manuals/ Policies and Procedures
    (?) MSD
    Educational Handouts
    Educational Models/Posters
    Folders/File Cabinets
    Pen Light
    Reflex Hammer
    Telephone Numbers (Rolodex)
    PDA

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