The ambulatory division of our health system encompasses 5 locations, 40 clinics, with a total of 150 nurses. Primary challenges in ambulatory consists of streamlining practices across diverse clinical settings, creating forums for representation, and providing opportunities for continued professional development.

The ambulatory clinical practice council was formed in 2016 and initially included 19 nurses along with several clinical managers and the senior director of ambulatory clinical practice. The first meeting provided an opportunity for members to brainstorm and organize ideas which guided the direction for future meetings. This initial opportunity for open discussion set the tone for an open and engaged environment where everyone had a voice at the table.

Meetings of the council are held monthly. Participation is voluntary; however, inactive members are proactively replaced, allowing for a robust and energetic core membership. The council is a safe place to bring and discuss concerns, as well as ideas for areas of improvement. Sub-committees were created to address areas of focus, and each month these committees report back on progress. Examples of changes driven by the council include updating the education documentation in the electronic medical record, as well as defining yearly competencies for ambulatory clinical staff. Best practices were identified and incorporated into ongoing discussions between clinics for unified telehealth responses and clinic operations. Council members serve as the conduit to other clinical staff in ambulatory, bringing concerns to the council and in return bringing updates back to staff. Our senior clinical director remains actively engaged and present at all meetings and serves as the direct pipeline to ambulatory leadership. This structure gives our council the ability to be change makers throughout the organization.

At the inception, the ambulatory shared governance council consisted of 19 members, 26% of which held certifications. There were no ambulatory members in the hospital-wide shared governance councils. The council is now 39 members strong with representation on 4 out of the 5 hospital-wide shared governance councils. There has been an increase in the presence of ambulatory throughout the organization, and efforts are continually being made to improve patient care across the continuum from inpatient to outpatient and everywhere in between. The ambulatory clinical practice council currently boasts 3 out of 8 hospital system-wide nursing award winners and 44% certified nurses.

Ambulatory clinical practice council members have received recognition for their contributions by both the organization as well as in the community, having received multiple nurse excellence awards. Prior to the ambulatory council’s formation, no nurses in ambulatory had ever been nominated or received these honors. Since the council was formed two years ago, 30 ambulatory nurses have been nominated or won these accolades.

Recently, the council has incorporated medical assistants into our council, solidifying an interdisciplinary team. This model is one of sustainability that can be replicated. Through the creation of an ambulatory clinical practice council, there has not only been an increase in clinical staff engagement and leadership development, but most importantly improved patient care and satisfaction.

Sally Derrick BSN, RN, CPN

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