Applying the AAACN Ambulatory Care Registered Nurse Residency Program Orientation in an Ambulatory Care Setting: A Quality Improvement Project to Increase Competence, Confidence, and Job Satisfaction in Clinical Staff

Studies have demonstrated that ambulatory care settings frequently hire newly graduated clinical staff, or often those with only acute care experience (Kovner, et al., 2007). Additionally, high turnover of clinical staff often occurs which can negatively impact the client experience, and organizational effectiveness, efficiency, and costs which are important domains of healthcare quality (Steifel & Nolan, 2012). Moreover, staff turnover has recently been identified as a nurse sensitive measure for ambulatory care settings. This measure informs ambulatory care nurses and team members to use local evidence to guide decision-making for quality improvement. Furthermore, benchmarking performance on structural issues, such as turnover, staff mix, and satisfaction will likely lead to better understanding the impact of staffing on processes of care and client outcomes (Collaborative Alliance for Nurse Outcomes, 2016).

To consider improvements in staff turnover, a quality improvement project – a newly designed precepted orientation program was developed based on best practices, utilizing AAACN standards (2018) to address staff satisfaction, confidence, and competence. The DNP student, as a full-time practicing NP within the ambulatory care center, served as project leader, and the center’s nurse educator served as site champion. The PICO question asked: Among newly hired clinical staff, what impact does an evidence-based standardized preceptorship orientation program, compared to the traditional orientation approach, have on staff competence, confidence, and satisfaction as intermediate outcomes to staff turnover? This project applied Lewin’s theoretical model: Unfreeze, change, and refreeze as the process for change (Cummings, Bridgman, & Brown, 2016) to the embedded Benner and Knowle's framework of the customizeable AAACN preceptor education and ambulatory care nurse residency material and the Casey-Fink graduate nurse experience survey to evaluate pre- and post-intervention change.

This poster describes the findings from this project, highlighting results from both preceptor and new clinical staff perspectives. Results indicated staff competency levels increased from pre- and post-evaluation measurement periods across all skills, both professionally and procedurally. The preceptor training results indicated that the majority of preceptors felt more confident in their abilities to precept the new clinical staff, as well as expressed a greater appreciation for the importance of the preceptor role. This small test of change provides important findings to build upon with further utilization of AAACN’s standards and best practices.

Lastly, this poster presentation addresses specific conference objectives, that is: strengthening leadership skills in the ambulatory care specialty, develop strategies for professional practice in ambulatory care, and promoting best practices through education. Adapting best practices to meet the needs of the fiscally challenged ambulatory care environment is particularly emphasized. The role of the DNP as a leader, collaborator, and team member in advancing quality improvement, evidence-based practices, and professionalism in the ambulatory care setting will also be especially highlighted.