It’s clear that the role of the professional nurse in healthcare has been diverging into areas that simply didn’t exist a decade or so ago. One of these areas is the “Access Nurse” position. The position is being implemented in many facilities to ensure a cohesive admission environment for incoming patients. Often referred to as the air traffic controller of the hospital, the Access Nurse is a new component in the drive to streamline care. The Access Nurse is an amalgamated position which encompasses utilization review, bed placement, and in practice, centralized trouble-shooting on countless issues.
First Point of Contact
The Access Nurse is the direct contact when admissions to the hospital are required. These admissions may come internally from the emergency department, or they can be from tertiary facilities needing a higher level of care. Simple direct admissions from local family practices channel to the Access Nurse as well, who then arranges for contact between the referring provider and the Hospitalist representing the facility.
Seemingly simple issues such as placing the patient in an appropriate bed can have consequences, so the Access Nurses needs more in-depth knowledge of the patient’s from the beginning of the process. A background of nursing knowledge is necessary to ensure appropriate placement, and to avoid less than optimum conditions for care. Certain patients may require a specific unit due to identified medications or conditions.
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Complex Review Processes
The next component that falls under the Access Nurse care paradigm is that of initial utilization review. The Access Nurse is involved in the admission process from the very beginning, so he or she in a unique position to know the relevant details to begin the process. Appropriate status comes from physician orders, but the Access Nurse is a wealth of information to ensure that the proper status, and thus appropriate reimbursement is realized. Often times even midsized hospitals do not have 24 hour utilization review, and the Access Nurse can fulfill this role, ensuring timely completion of items like Medicare required Condition Code 44’s. The Access Nurse is also a 24-hour centralized contact area for issues such as Medicare Appeals.
The trend towards increasing complexity and new regulatory imperatives makes it a wise decision for facilities to utilize Access Nurses in their facility. Fragmentation is a distinct enemy in the quest for excellent care, not to mention reimbursement that adequately reflects the care given. The role of the Access Nurse is a newly forged position to combat these issues, and often serves as a helpful troubleshooting contact for diverse issues such as computerized charting mishaps. Simply having a professional nurse in this position ensures that time consuming problems are thwarted before they occur. This frees up the often higher paid positions such as House Supervisors and Charge Nurses, making the use of Access Nurses financially prudent.
Nursing has branched out into diverse arenas, many of which we wouldn’t have anticipated years ago. The rapidly changing environment requires a creative use of resources and the utilization of the Access Nurse position does just that.
Kathleen Wallace is an access nurse at St. Francis Health Center, Topeka, Kansas.
