Licensed practical nurses (LPNs) new to ambulatory care practice traditionally have not had robust programs for orientation, leaving a multifaceted gap in this rapidly growing area of practice. Unit-based orientation was left to managers. Many clinics have business managers, not nurse managers, creating a wider gap in LPN ambulatory care practice.

As a new vice president of ambulatory care nursing and director of education role was identified, allowing our organization to take a wider lens to evaluate our LPN transition- to-practice program. Literature was reviewed for strategies of successful existing programs. We found one LPN transition-to-practice program and talked with the designer. We discovered it was inpatient-focused with no ambulatory care component. Our original LPN transition-to-practice program evolved into a learning event for all ambulatory care nurses with poor attendance. We reviewed existing RN transition-to-practice program content, consulted managers, and successful ambulatory care LPNs to determine the needs of LPNs new to ambulatory care. The program was redesigned spring of 2020. LPNs are grouped into three-month cohorts after attending a one-day jumpstart class. We included our ambulatory care nursing leaders and NPD specialists as primary stakeholders in the review of quarterly education offerings. With their support, strategies to overcome attendance barriers included a virtual attendance option with learners completing pre-work in our learning management system prior to the live event. The virtual classroom reduces time away from direct patient care by eliminating travel and allowing attendance of all new LPNs from clinics in multiple locations. Another strategy was to present the ambulatory care LPN transition-to-practice program to all clinic managers with direct support from nursing executives. We encouraged leaders to created dedicated professional development time for the learners. Managers, in some cases, provided additional staff coverage for this time frame. Finally, the cohort design allows a dedicated ambulatory care nursing education specialist to lead quarterly classes building individual ambulatory care skills, competency, and relationships. To measure success of the program an evaluation was designed. The first evaluation is given after the jumpstart class and then repeated at 6- and 12-month intervals to measure competency and confidence of our new LPN staff. We have developed a dashboard to track retention of participants. The goal of the program is to increase competence, improve patient-centered care, and increase LPN satisfaction and retention.

Identification of professional practice gap:
Current state: A large academic medical center with a substantial ambulatory care nursing practice setting had a failed LPN transition-to-practice program.
Desired state: Redesign the LPN transition-to-practice program with updated content and increased attendance by gaining ambulatory care leader support.

Learning outcome: After this presentation, the learner will identify benefits of a robust LPN transition-to-practice program to aid a graduate practical nurse or new ambulatory care LPN by providing learning opportunities to build and improve competency in the care of the ambulatory care patient.

Ann Benco MS, BSN, RN, CNOR

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