HYBRID EVENT: You can participate in person at Boston, Massachusetts, USA or Virtually from your home or work.

7th Edition of Nursing World Conference

October 16-18, 2023 | Boston, Massachusetts, USA

October 16 -18, 2023 | Boston, Massachusetts, USA
NWC 2022

Denise Fleming Weiler

Speaker at  Nursing World Conference 2022 - Denise Fleming Weiler
Montana State University Bozeman, United States
Title : Emergent care readiness in a vha community-based outpatient setting


Background: In 2016, the Department of Veterans Affairs (VHA) transformed its healthcare system to increase veterans' access to services. The new guidelines promised mental health and primary care "Same Day Services for Veterans with the most urgent needs" (Department of Veterans Affairs, 2018). In 2018, VHA nationwide provided 12 million same-day appointments to veterans throughout their VHA facilities. Veterans present to outpatient clinics with emergent needs, including acute coronary syndrome (ACS), acute cardiovascular accident (CVA), hypoglycemia, hyperglycemia, and hypoxemia, and require the clinical staff to act fast. All outpatient primary care clinical staff maintain a BLS certification but receive no other training for addressing these emergent situations autonomously. All care during these emergent situations must be directed by a licensed independent practitioner (LIP). The VHA does not have standardized processes or protocols for primary care nursing staff to implement emergent interventions autonomously while practicing within the nurse's scope as defined by the respective state board of nursing. Evidence has shown that early intervention in these emergent situations (e.g., ACS, CVA) yields better outcomes (American Heart Association, 2020).

Aim: Demonstrate an improvement process for implementing emergent care nurse-driven protocols in outpatient primary care settings to yield better patient outcomes.

Design: Culture of safety quality improvement project

Description: Badge Registered outline

Methods: The VHA outpatient setting will collaborate with the American Heart Association (AHA) to employ the AHA Mission: Lifeline for stroke and acute coronary syndrome. Utilizing current evidence-based practice guidelines for nurse-driven protocols to address emergent situations in primary care settings will ensure that veterans seeking care for an emergent condition receive the best care.

Results: Further research could yield better practices for successfully implementing emergent care protocols in outpatient settings.

            Keywords: veterans, primary care, emergent care, stroke (CVA), heart attack (MI) 


Denise Fleming-Weiler graduated from St. Elizabeth College of Nursing in 2013. She began her career as a critical care nurse in a Progressive Care Unit. She then simultaneously worked in an outpatient clinic. She spent eight years as a patient-aligned care team RN care manager for the Department of Veterans Affairs community-based outpatient clinic. She received a recent promotion to a Systems Redesign RN. Mrs. Fleming-Weiler is currently in her final two semesters of graduate school.