Forging Connections: Leveraging Nursing Orientation to Promote Ambulatory Care Clinical Leadership Structure

Repeated travel of signals through neuropathways, consistent exercise of large muscle tissue, or the diversion of blood flow through a lesser artery when main routes are blocked result in creation of new patterns, born out of repetition and new necessity. Often, purposeful activity to develop brain, muscle, or even organizational structure is avoided, as commitment to the goal requires overwhelming or unavailable information and resource.

What if the repetition needed for success occurs as a consequence of a different, yet related activity of established value? This may force the enhancement of the muscle, pathway, or desired change as an “unintended” consequence, which, once in place, may be hard to live without.

Registered professional nurses add specific value to ambulatory care practices by impacting quality measures, clinical, organizational, and financial outcomes. Nursing activity has been shown to reduce readmission, promote safety, reduce risk, and improve overall health of communities.

Where ambulatory care centers are overseen by administrative business personnel, clinical roles can be misunderstood and underutilized. Administrative staff are ill-fitted to evaluate clinical competence and supply needed mentorship/education. RNs lack support to advocate for processes that align with professional licensure and responsibilities.

To be effective and practice at highest levels, RN staff need defined oversight, decision-making, and support from expert clinical leaders. However, lacking systems for comparison, coupled with inadequate awareness or research on the impact of nursing services, organizational decision makers have no basis for evaluation.

In our service line of 150 ambulatory care medical and specialty practices, we faced the challenge of a growing RN staff with no mechanism for appropriate recruitment, hiring, and orientation. As complete structural change requires the highest level of organizational commitment over an extended period of time, our small team focused energy on the most critical needs: 1) implementing processes to vet RN candidates by clinical experts and 2) providing structured individualized orientation, created and delivered by qualified nurse educators.

During this presentation, we will describe our beginning in terms of leadership structure, nursing team, hiring, education, and orientation. We will highlight initial interventions, implementation of centralized RN recruitment, evidence-based orientation, and ongoing support for education and professional development. A small qualitative report of RN responses will demonstrate potential impact.

Through tedious repetition of education and messaging, our administrative peers have become appreciative of and reliant on the clinical support we provide. With robust orientation and education programs, we inadvertently forced the aligned concepts of role definition, nursing scope, and breadth of practice.

At the start of the hour, each participant will be asked to supply, one pain point related to nursing education and orientation. Upon conclusion, they will submit an example of an implementation that paved the way for related change. Submissions will be reviewed.

As nurses, using creative strategy to impact patient care and our profession, often with limited resources, has been the backbone and pride of our nursing community. Main objectives are to share our discoveries and inspire participants to consider one creative strategy they can implement toward an important goal.