Novel Ambulatory Care-Focused Learning within the Student Nurse Practicum Experience

Purpose: The purpose of this project was to partner ambulatory services (AS) nursing leaders and staff with the affiliated school of nursing (SON) students to provide a unique student nurse practicum focused on blending key acute and ambulatory care skills that support the population health across the care continuum.

Background/significance: A growing focus on population health and cost containment in the US healthcare delivery system has increased the demand for registered nurses (RN) in ambulatory care settings. Despite this growing need, schools of nursing struggle to find appropriate placements that provide ambulatory care-focused clinical experiences. These gaps in education and experience create significant challenges in meeting today’s health care demands. Innovative pre-licensure clinical education experiences outside the acute care setting will fully prepare nurses for this role.

Methods: The project team designed a blended acute and ambulatory care pilot practicum for nursing students in their final semester. The pilot lasted 3 semesters, with 3 cohorts totaling 10 student participants. Outpatient preceptors participated in pre-program training and post-program debriefing. Students were placed in 6 sub-specialty outpatient centers and 4 inpatient units. Students started with inpatient rotations and then transitioned to ambulatory care units where they cared for patients with similar conditions. The ambulatory care rotation focused on skills that support value-driven care such as care coordination, interprofessional care planning, post-hospitalization follow-up, patient and family teaching, and community outreach.

Results: Students and ambulatory care preceptors completed questionnaires evaluating the program structure and its effectiveness in preparing students to transition to practice. All preceptors and students in the first cohort recommended an increase in inpatient hours to maximize acute care skills development; the ratio was changed for remaining cohorts to 60% inpatient hours and 40% outpatient hours. Ambulatory care preceptors requested more input on student schedules, enabling them to be exposed to a greater variety of clinical experiences. Current completion data indicates 100% of students increased their understanding of the outpatient nurse’s role and 71% will consider working in ambulatory care at some point in their career. 28% of students commented that they felt the ambulatory care setting could provide a healthier work/life balance.

Conclusions/implications for practice: The practicum experience successfully provided nursing students an opportunity to develop essential ambulatory care nursing skills as they transition from the classroom to independent nursing practice. Integrating experiential ambulatory care learning the throughout pre-licensure nursing curriculum should also be explored.

References
1. American Academy of Ambulatory Care Nursing. (2017). Ambulatory Care Registered Nurse Residency Program: Transition to the Specialty of Ambulatory Care. J. Levine (Ed). Pitman, NJ.
2. Shaffer, Kathleen, Swan, B. & Bouchaud, Mary. (2018). Designing a New Model for Clinical Education: An Innovative Approach. Nurse Educator, 43(3), 145-148. doi:10.1097/NNE.0000000000000468
3. Windey, Maryann & Fritz, E. (2017). Transition to Practice in Ambulatory Care Nursing. Journal for Nurses in Professional Development, 33(5), 257-258. doi:10.1097/NND.0000000000000376