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Nursing Autonomy - Working to Full Scope of Practice

Teresa Bell-Stephens, BSN, RN, CNRN, Effie Kan, MSN, RN, Sarah Kahn, MSN, RN, CNS, Truman Cowles, MHA, BSN, RN

The Neuroscience Health Center is a high-volume center treating complex patient populations referred from community providers.  Our goal is always to improve efficiency and patient access to health care.  We also wanted to be able to account for how RNCs are utilizing time spent with patients. 

Beginning in late 2021, the Neuroscience Health Center participated in the ACTION (Ambulatory Care Team Improvement and Optimization) initiative to ensure all staff worked at their highest scope of practice within their license or certification.  Nursing Autonomy was a lower score on our 2021 NDNQI survey, and our team dedicated initiatives in an A3 towards improving this.  One of these efforts was developing nurse-led visits.  


As part of this endeavor, we undertook the opportunity to establish a process for determining how the registered nurse coordinator (RNC) could provide nursing visits for patients in the ambulatory setting working within the full scope of nursing practice.  

RNC visits enable complex patients to be seen one-on-one for additional, comprehensive care and education and more regularly between provider visits to determine response to treatment.
The Neurovascular Surgery RNC team initiated billable RNC visits and expanded to eight neurosciences subspecialty teams.  
The implementation of having RNCs see patients decompresses provider clinics to provide greater access for new and returning patients.  

We aim to continue expanding RNC visits into other subspecialties in our clinic.  Providers within the participating subspecialties have been supportive and agree that patients benefit from this added level of care.  Feedback from the RNC has been that they felt patients benefited from the one-on-one time spent with the patient providing a higher level of nursing-coordinated care.  


Dr. Michelle Y. Williams, PhD, RN, Executive Director of ORPCS

Dr. Michelle Y. Williams, PhD, RN, Executive Director of ORPCS, has been named Founding Chief of the Nursing Research Section at Stanford University School of Medicine. In this role she will work closely with Dr. Steve Asch, MD, Vice Chief of Primary Care and Population Health for Research.

"We believe that by building alliances between our academic institution, nursing, and interprofessional researchers, and the community—we will inspire advances in health equity and research."

The mission of Nursing Research Section is to advance health equity, nursing practice, patient care, and research across Stanford Medicine and society-at-large through leading, developing, sponsoring, and sustaining research partnerships with our PCPH Division and the larger Stanford School of Medicine, community-based organizations, nursing academia, and care delivery institutions.

In addition, Dr. Williams was elected to serve on the Research Committee of the National Black Nurses Association. The NBNA serves as the professional voice for over 200,000 African American registered nurses, licensed vocational/practical nurses, nursing students and retired nurses from the USA, Eastern Caribbean and Africa.

Dr. Lynette Apen

Elected to the Board of Directors of the Western Region for the Organization for Associate Degree Nursing (OADN) 

Dr. Lynette V. Apen, DNP, RN, Director of Research Operations & Strategy at ORPCS has been elected to a 2-year term on the Board of Directors representing the Western Region for the Organization for Associate Degree Nursing (OADN).


OADN continues to be the national voice and advocacy for community college nursing education and the associate degree pathway by providing advocacy for the over 1100 associate degree Nursing Programs throughout the United States.

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