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  • 1.  Staffing ratios for RN/LPN for Ambulatory Care clinics

    Posted 12-12-2025 18:26
    Dear Amazing Colleagues in FQHC's

    We are looking at strategies for fiscal accountability and our current nursing structure is to have RN's (CHN's) and LPN's (function as panel managers) in the clinic as well centralized PAC RN's for triage. As I look at our total FTE for nursing (85 FTE) compared to our provider FTE (54.7) not counting clinical pharmacist, PMHNP and Fellows. 

    I am requesting other models regarding nursing staffing ratios (clinic settings). Currently our nurses in the clinic setting provide support for walk-ins, triage, wound care, diabetes education, hypertension management, INR/anticoag, prenatal care, medication adherence strategies, Sublocade/Brixadi administration, long acting injectables, and other nursing functions. 
    Thank you for your wisdom.

    Toni Kempner, BSN, MSN, RN, ACRN
    Director of Nursing 
    Integrated Clinical Services (ICS)
    Multnomah County Health Department
    619 NW 6th Avenue, 7th floor, Interoffice: B165/7
    Portland, OR  97209
    Cell: 503-969-6989

    For Scheduling and Administrative Support: Jodi Shaw at jodi.k.shaw@multco.us





  • 2.  RE: Staffing ratios for RN/LPN for Ambulatory Care clinics

    Posted 12-12-2025 18:31

    Dear Colleagues,

    I apologize for my error in the nursing FTE it is only 48 and the Provider FTE is 85 (unfortunately I am multitasking while I sent out this message). I regret this error.



    ------------------------------
    Toni Kempner RN, MSN, ACRN
    Director of Nursing
    Multnomah County HD, ICS
    Portland, OR
    503-969-6989
    ------------------------------



  • 3.  RE: Staffing ratios for RN/LPN for Ambulatory Care clinics

    Posted 01-02-2026 19:44

    This is a great discussion and I would like to add that different states have different scope of practices for MA vs LPN vs RN. An MA in NY is an information gatherer yet in other states they can give injections and handle medications. So setting up a standard of practice may be hampered by state rules and regulations and that will need to be taken into consideration. 



    ------------------------------
    Elizabeth Anderson MSN AMB-BC
    Retired
    Port Ewen NY
    (914) 466-8524
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  • 4.  RE: Staffing ratios for RN/LPN for Ambulatory Care clinics

    Posted 01-04-2026 14:07

    Our current model in pediatric primary care is very RN heavy. We are adjusting team roles and adding more MA coverage to our team. Currently we have a mix of RN care managers, RNs (Team Leaders, walk in nurses, Call nurses), minimal LPNs and a few MAs. Additionally, we have patient care technicians to assist with the flow of the clinic. We are currently in the process of desk audits of our team and identifying which role it makes the most sense to complete work in the clinic. The goal is to decrease the cost of care and be more efficient to provide a great experience and see more patients. We have work ahead of us. I'd be interested to see how others are staffing primary care as well. 

    Shelly Keller, MNSc, RN, NE-BC

    Director, Primary Care Clinics

    Arkansas Children's Hospital

    1 Children's Way  Little Rock, AR 72202

    501-364-6686 office l (501)231-1289 cell 
    Website  Facebook  Twitter LinkedIn



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    Shelly Keller MSN
    Director, Primary Care
    Sherwood AR
    5013646686
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  • 5.  RE: Staffing ratios for RN/LPN for Ambulatory Care clinics

    Posted 01-05-2026 09:25

    Hello,

     

    We have a separate care management team for our primary care clinics (32 total).

     

    Embedded team members: up to 1.0 FTE RN Care Manager and 1.0 FTE MSW. Some clinics are smaller so we have some part time staff and full time that cover multiple offices.

    • 30 RNs
    • 28 MSWs

     

    Transition of Care team: some are also part time on this team.

    • RNs: 6 (2 are 0.6 FTEs)
    • MSWs: 7 (3 are 0.6 FTEs)
    • MAs: 4 (all full time)

     

    We also have 4 support assistants and a team for Collaborative Care (6 1.0 FTE MSWs).

     

    Our practices use MAs for rooming patients. Some clinics have nurse roles to assist but mainly pediatrics. We also have a separate nurse triage department.

     

    I hope this helps!

     

    Kind regards,

    Ashley Rosa, MSN, BSN, RN

    Manager Ambulatory Care Management

    Bronson Healthcare Group, Michigan

     

     



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