Date of Award

Spring 1993

Document Type

Thesis - Restricted

Degree Name

Master of Science (MS)

Department

Nursing

First Advisor

Wake, Madeline

Second Advisor

Malin, Michelle

Third Advisor

O'Brien Maureen

Abstract

Providing health care services in an efficient and effective manner is of utmost importance in society today. With the shift to managed care in the last few years, more and more is being done on an outpatient basis. The challenge is to do more with less. Because health care is becoming more and more of a business, every full time equivilent [sic] (FTE) needs to be justified at budget time. A tool to determine FTE's is useful for budget justification as well as to meet accreditation requirements (JCAHO, 1991). Determining the number of FTE's in an ambulatory setting is a challenge because there are not many tools developed that are applicable to the ambulatory setting, especially the pediatric ambulatory setting. There is an outpatient classification system that was developed by Verran (Verran 1986b). This tool, however, is not easily utilized in all ambulatory settings. After reviewing the literature, it was determined the first step in developing a tool was to do a workload analysis. The diabetes and neurology specialty clinics were chosen to study at a midwest children's hospital. The two clinics were speculated to be similar in nursing functions, however, in looking at the two specialty clinics, the role of nursing was found to be very different from one ambulatory pediatric setting to the next. The nursing activities were able to be captured and categorized under similar headings. Telephone calls were also captured and the types of calls were defined. Telephone calls required much of the nurses' time for direct patient care . Other activities related to patient care were found to consume much of the nurses time. The time nurses spent in actual clinics was much less than anticipated. The importance of this study was to look critically at the role of the pediatric ambulatory nurse and to use the information in determining the future role, as well as justification for the current role and FTE ' s for the specialty clinics analyzed. Outpatients require different nursing activities than the inpatient. There is a need to capture the activities in relation to the patient requirements in the outpatient setting. The development of a classification instrument for the pediatric ambulatory' setting could be developed for generalities, but the specific activities would be very hard to capture due to the wide variety of nursing functions from one specialty to the next.

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