Purpose: As healthcare transforms and rapidly expands from inpatient to outpatient sites, the role of nursing continues to expand in ambulatory care settings. Ambulatory care nurse coordinators (NCs) provide coordination and care for patients requiring assistance and support in accessing and managing their healthcare needs. The development and implementation of a clinical ladder program has implications for improving nursing retention and engagement for ambulatory care nurse coordinators. Although the concept and benefits of nursing clinical ladder programs have been documented since the 1970s, little research exists discussing the implementation of such programs for NC roles in ambulatory care.

Description: A large academic health system in Northern California developed and implemented a clinical leadership and career advancement program to recognize and reward the professional excellence of ambulatory care NCs across the enterprise. From 2020 to 2021, this program was built by the ambulatory care nursing department in collaboration with a consulting firm specializing in nursing care optimization and facilitated with the partnership of ambulatory care nursing professional development specialists in the organization. The program’s framework was established utilizing concepts from Patricia Benner’s nursing theory and the American Academy of Ambulatory Care Nursing scope and standards of practice for professional ambulatory care nursing, with the following objectives: acknowledge and enhance NC career development, attract and retain high-quality nursing staff, and create a supportive work environment that values NC growth.

Evaluation/outcome: In September 2021, a total of eight ambulatory care nurse coordinators were successfully promoted in the inaugural cohort of the clinical ladder program. 100% of promoted NCs maintained an American Nurses Credentialing Center-accredited nursing certification, held a bachelor of science in nursing degree or higher, worked as NCs within the organization for a minimum of 12 months and within their clinical specialty for a minimum of three years, and were members of professional nursing organizations. Promoted NCs demonstrated clinical expertise and were significantly involved in professional development and leadership opportunities within the organization, including the ambulatory care shared governance council. Metrics indicating program success include reduced staff turnover and improved staff engagement. The next steps for the ambulatory care nursing department involve the measurement of such staff outcomes to further understand the successes of the program and areas of opportunity. The program is anticipated to mirror the successes of its inpatient counterpart in advancing, promoting, retaining, and engaging ambulatory care nurse coordinators.

References
1) American Academy of Ambulatory Care Nursing, & Murray, C. L. (2017). Scope & Standards of Practice for Professional Ambulatory Care Nursing (9th ed.). American Academy of Ambulatory Care Nursing.
2) Benner, P. (1982). From Novice To Expert. AJN, American Journal of Nursing, 82(3), 402–407. https://doi.org/10.1097/000004...
3) Pierson, M. A., Liggett, C., & Moore, K. S. (2010). Twenty Years of Experience with a Clinical Ladder: A Tool for Professional Growth, Evidence-Based Practice, Recruitment, and Retention. The Journal of Continuing Education in Nursing, 41(1), 33–40. https://doi.org/10.3928/002201...

Julie Tisnado MSN, RN, CNRN

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