Allece Merchant, MBA, BSN, RN, NE-BC, Director of Ambulatory Clinical Initiatives, UT Southwestern Medical Center | Alisha Orton, MS, BSN, RN, CMPE
Updated: 03/07/24
In the interest of cost-effectiveness, efficiency, and employee satisfaction, medical assistant (MA) responsibilities can be tailored to the needs of a practice. In a large academic medical center with over 100 specialty clinics, it was difficult to gain consistency in MA responsibilities. Although an evidence-based institutional guiding document outlines approved performance tasks, it is the obligation of clinic leaders to staff the appropriate skill mix according to workflows.
Given the national shortage of available MAs, annual turnover rates of 20-30%, and replacement costs that reach 40% of the MA annual salary, it is imperative to assess MA, medical practitioner, and nurse concordance on delegation authority and delegable tasks. Integrating more highly skilled tasks into the MA role creates differentiation on the career ladder that can promote employee retention.
Qualitative insights into actual and potential MA tasks were collated through direct observations, interviews, and in group forums from an interdisciplinary team of MAs, nurses, leaders, and medical practitioners. A group of key stakeholders was formed to evaluate these insights against state regulations, payment models, and institutional and national evidence-based best practices. Task inconsistencies were analyzed for root causes, and opportunities to expand the MA scope to more advanced skills were evaluated for workflow efficiencies.
In general, the findings showed consensus amongst healthcare staff that the MA role is underutilized and brought to light a common misconception that the MA functioned under the authority of the registered nurse rather than the provider. Organizational MAs primarily expressed a willingness and confidence in their ability to perform more highly skilled tasks with the appropriate training. Three patient care categories emerged as focus areas to narrow inconsistencies in practice: rooming process, documentation (pain screen, health maintenance, allergies, medication intake), and medication administration. Of the thirteen potential tasks considered, five were deemed not feasible: create and sign medication orders, ultrasound-guided procedure monitoring, medication refills, complex wound dressings, and insertion of peripheral IVs. After a thorough review, eight new tasks were added to the approved MA task list: communication of abnormal results or simple prescription changes, CGM placement, peripheral IV removal, patient forms, renewing expired lab orders, updating lab order location, and orthopedic casting.
Healthcare delivery model reform begins with education and a mutual understanding of roles and responsibilities. Once achieved, implementation depends on the willingness of medical practitioners to delegate, nurses' agreement to relinquish tasks, and medical assistant buy-in to assume new responsibilities. The pace at which change can be implemented is contingent on clinic leaders' evaluation of workflows, redistribution of tasks, modifications to team composition, and training of MAs to the newly delegated tasks. Patient outcomes and the ability to retain MAs will be indicators of scope optimization effectiveness. A successful culture shift is ultimately dependent upon staff engagement, satisfaction, and a value-based payment model.
Future analysis will focus on licensed vocational nurse overlap of tasks with MAs. We will also explore opportunities to optimize registered nurses to top-of-license practice with care coordination, care management, patient education, and billable services.
Given the national shortage of available MAs, annual turnover rates of 20-30%, and replacement costs that reach 40% of the MA annual salary, it is imperative to assess MA, medical practitioner, and nurse concordance on delegation authority and delegable tasks. Integrating more highly skilled tasks into the MA role creates differentiation on the career ladder that can promote employee retention.
Qualitative insights into actual and potential MA tasks were collated through direct observations, interviews, and in group forums from an interdisciplinary team of MAs, nurses, leaders, and medical practitioners. A group of key stakeholders was formed to evaluate these insights against state regulations, payment models, and institutional and national evidence-based best practices. Task inconsistencies were analyzed for root causes, and opportunities to expand the MA scope to more advanced skills were evaluated for workflow efficiencies.
In general, the findings showed consensus amongst healthcare staff that the MA role is underutilized and brought to light a common misconception that the MA functioned under the authority of the registered nurse rather than the provider. Organizational MAs primarily expressed a willingness and confidence in their ability to perform more highly skilled tasks with the appropriate training. Three patient care categories emerged as focus areas to narrow inconsistencies in practice: rooming process, documentation (pain screen, health maintenance, allergies, medication intake), and medication administration. Of the thirteen potential tasks considered, five were deemed not feasible: create and sign medication orders, ultrasound-guided procedure monitoring, medication refills, complex wound dressings, and insertion of peripheral IVs. After a thorough review, eight new tasks were added to the approved MA task list: communication of abnormal results or simple prescription changes, CGM placement, peripheral IV removal, patient forms, renewing expired lab orders, updating lab order location, and orthopedic casting.
Healthcare delivery model reform begins with education and a mutual understanding of roles and responsibilities. Once achieved, implementation depends on the willingness of medical practitioners to delegate, nurses' agreement to relinquish tasks, and medical assistant buy-in to assume new responsibilities. The pace at which change can be implemented is contingent on clinic leaders' evaluation of workflows, redistribution of tasks, modifications to team composition, and training of MAs to the newly delegated tasks. Patient outcomes and the ability to retain MAs will be indicators of scope optimization effectiveness. A successful culture shift is ultimately dependent upon staff engagement, satisfaction, and a value-based payment model.
Future analysis will focus on licensed vocational nurse overlap of tasks with MAs. We will also explore opportunities to optimize registered nurses to top-of-license practice with care coordination, care management, patient education, and billable services.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/07/24
Background: Cultures centered around patient safety in high-reliability healthcare institutions are important and can positively influence staff job satisfaction and patient. More than 14 million colonoscopies are completed annually in the United States. High-quality endoscopy starts with high-quality education. Offering educational programs to staff nurses and gastrointestinal (GI) techs working in endoscopy units is essential to providing safe and effective patient care. To prevent additional staff workload, ambulatory surgery center (ASC) nurse leaders must creatively tailor educational training to enhance staff knowledge and performance.
Methods: After completing a comprehensive review of best practices, a formal training program was developed. Nurse leaders in a busy endoscopy center in Atlanta, GA, partnered with a reputable medical solution corporation to tailor an educational program for registered nurses (RNs) and GI technicians. The program went live July 2022 and provided didactic and hands-on training of various endoscopy topics. Nurse managers and a field educator coordinated onsite training sessions using a cohort model. New and experienced endoscopy staff completed training during their scheduled workday. Training took five weeks to complete.
Results: 29 staff members from four different ASCs completed the training program. 24% (n=7) of the staff were GI technicians. 68% (n=20) were RNs. One sterile processing technician and one patient care technician also completed the training. 35% (n=10) of the staff completed a post-survey to share feedback. 90% (n=9) strongly agreed hands-on practice improved their confidence in GI disease states and procedures. 70% (n=7) strongly agreed they are prepared to apply acquired skills to their practice. 80% (n=8) would recommend the training to a colleague. One respondent recommended more hands-on experience be added to the program. All others mentioned that the training was adequate.
Conclusion: Due to post-covid staffing challenges, endoscopy nurse leaders effectively reassessed the learning needs of their staff. Upon review, it was determined that a learner-centered approach to training was needed. Innovative training experiences improved staff competence, employee engagement, and empowerment. The educational curriculum successfully bridged the gap between staff knowledge and the ever-changing practice environment.
Methods: After completing a comprehensive review of best practices, a formal training program was developed. Nurse leaders in a busy endoscopy center in Atlanta, GA, partnered with a reputable medical solution corporation to tailor an educational program for registered nurses (RNs) and GI technicians. The program went live July 2022 and provided didactic and hands-on training of various endoscopy topics. Nurse managers and a field educator coordinated onsite training sessions using a cohort model. New and experienced endoscopy staff completed training during their scheduled workday. Training took five weeks to complete.
Results: 29 staff members from four different ASCs completed the training program. 24% (n=7) of the staff were GI technicians. 68% (n=20) were RNs. One sterile processing technician and one patient care technician also completed the training. 35% (n=10) of the staff completed a post-survey to share feedback. 90% (n=9) strongly agreed hands-on practice improved their confidence in GI disease states and procedures. 70% (n=7) strongly agreed they are prepared to apply acquired skills to their practice. 80% (n=8) would recommend the training to a colleague. One respondent recommended more hands-on experience be added to the program. All others mentioned that the training was adequate.
Conclusion: Due to post-covid staffing challenges, endoscopy nurse leaders effectively reassessed the learning needs of their staff. Upon review, it was determined that a learner-centered approach to training was needed. Innovative training experiences improved staff competence, employee engagement, and empowerment. The educational curriculum successfully bridged the gap between staff knowledge and the ever-changing practice environment.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Jana Evenhouse, MSN-S, BSN, RN, AMB-BC | Cindy Naveira, MSN, RN, ACNP-BC, CENP | Veronica Pagán, MPH, MA | Suzanne Silva, MSN, RN, CEN | Kelly Vecchiarelli, DNP, RN, APRN-BC, AMB-BC, CPHQ
Tags:
medical chaperones
sensitive health examination
trauma-informed care
high-reliability organization
Updated: 03/07/24
Purpose: To establish a medical chaperone program in the ambulatory care setting and transform organizational culture where medical chaperones become a standard of care during a sensitive health examination.
Background/significance: A sensitive health examination involves the genitalia, rectum, or breast. It creates vulnerability for both the clinician and the patient. A review of literature confirms a medical chaperone should be present during a sensitive health; however, program implementation is poorly documented in the literature. Understanding how previous trauma may impact a patient’s experience during a sensitive health examination, the addition of trauma-informed care was included in education and training. Medical chaperones are trained members of the healthcare team who observe and assist during a sensitive health examination. Their presence improves patient safety and reduces vulnerability and risk.
Methods: Ambulatory care nursing leadership established a medical chaperone program with support from all levels of the organization utilizing the PDSA model to implement change. This involved policy development, staff and clinician training, patient education, and addressing workforce needs. Training included observation of the exam, the ability of the patient, clinician, or medical chaperone to stop the exam, education about trauma-informed care, consideration of gender preference, and the documentation of the presence or declination of a medical chaperone. Identifying diagnosis and procedural codes specific to sensitive health examination allowed for chart audits when monitoring for compliance. Audits identified vulnerabilities and the need for additional training.
Results: Patient-facing clinical staff completed a knowledge assessment survey prior to medical chaperone education and six months following implementation. There was substantial improvement in staff knowledge of trauma-informed care (36% increase) and staff knowledge of how to document medical chaperone presence or declination (38% increase). The results further indicated staff were less concerned about workflow issues (4% decrease) following education.
Conclusion: Medical chaperones are essential during a sensitive health examination and provide protection for patients and clinicians during vulnerable moments of care. Including medical chaperones during a sensitive health examination as a standard of care transforms culture and is achieved through acceptance and compliance of all members of the healthcare organization. This poster is an overview of the process that cultivates high reliability in an organization with the implementation of medical chaperones.
Background/significance: A sensitive health examination involves the genitalia, rectum, or breast. It creates vulnerability for both the clinician and the patient. A review of literature confirms a medical chaperone should be present during a sensitive health; however, program implementation is poorly documented in the literature. Understanding how previous trauma may impact a patient’s experience during a sensitive health examination, the addition of trauma-informed care was included in education and training. Medical chaperones are trained members of the healthcare team who observe and assist during a sensitive health examination. Their presence improves patient safety and reduces vulnerability and risk.
Methods: Ambulatory care nursing leadership established a medical chaperone program with support from all levels of the organization utilizing the PDSA model to implement change. This involved policy development, staff and clinician training, patient education, and addressing workforce needs. Training included observation of the exam, the ability of the patient, clinician, or medical chaperone to stop the exam, education about trauma-informed care, consideration of gender preference, and the documentation of the presence or declination of a medical chaperone. Identifying diagnosis and procedural codes specific to sensitive health examination allowed for chart audits when monitoring for compliance. Audits identified vulnerabilities and the need for additional training.
Results: Patient-facing clinical staff completed a knowledge assessment survey prior to medical chaperone education and six months following implementation. There was substantial improvement in staff knowledge of trauma-informed care (36% increase) and staff knowledge of how to document medical chaperone presence or declination (38% increase). The results further indicated staff were less concerned about workflow issues (4% decrease) following education.
Conclusion: Medical chaperones are essential during a sensitive health examination and provide protection for patients and clinicians during vulnerable moments of care. Including medical chaperones during a sensitive health examination as a standard of care transforms culture and is achieved through acceptance and compliance of all members of the healthcare organization. This poster is an overview of the process that cultivates high reliability in an organization with the implementation of medical chaperones.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/07/24
Background: As with most ambulatory care settings, this academic institution lacked safe patient medication administration technologies available to the inpatient areas that reinforced best practices of scanning medications or vaccinations upon administration at the bedside. Errors of wrong medication and vaccination being administered to patients in the outpatient setting were identified through reporting from the medication safety committee when orders did not match medication administration documentation. A new EHR implementation prompted ambulatory care services to request barcode medication scanning technology for all ambulatory care clinics to facilitate safe patient medication administration.
Methods: Barcode medication administration was implemented in all 26 outpatient clinics in an academic institution to facilitate medication safety practices and reach 95% compliance congruent with LeapFrog standards of success. Monitoring and tracking the utilization of barcode medication scanning upon implementation identified that there were systemic issues with nursing knowledge in utilization of the technology, the importance for safe patient medication administration practices, and importance of adherence to identified workflows. Pre-data showed that medications were only being scanned approximately 35% of the time and immunizations 65% of the time. This led to a project manager being assigned to improve nursing practice in medication administration which adheres to prevention of errors and safe administration of medications to patients through utilization of barcode scanning.
Analysis: Post-evaluation of baseline metrics, a re-competency program for all existing nursing staff was developed to include skills return demonstration, problem-solving strategies on equipment, processes for reporting equipment, medications that do not scan, or workflow impediments. This education was integrated into the new-hire orientation for all oncoming staff. Identification of barriers and gaps led to process improvement changes and communication to nursing staff that did not adhere to workflows. Monthly metrics were presented to ensure constant feedback. Ongoing issues were discussed in a governance structure with pharmacy and nursing operations to create sustainability in the project.
Outcomes: Ambulatory care nurses have achieved and maintained compliance >95% for medication and vaccination administration from August 2021 to March 2023. Medication administration safety practices are adhered in the outpatient setting and continue to improve the patient experience and safety in a fast-paced environment.
Methods: Barcode medication administration was implemented in all 26 outpatient clinics in an academic institution to facilitate medication safety practices and reach 95% compliance congruent with LeapFrog standards of success. Monitoring and tracking the utilization of barcode medication scanning upon implementation identified that there were systemic issues with nursing knowledge in utilization of the technology, the importance for safe patient medication administration practices, and importance of adherence to identified workflows. Pre-data showed that medications were only being scanned approximately 35% of the time and immunizations 65% of the time. This led to a project manager being assigned to improve nursing practice in medication administration which adheres to prevention of errors and safe administration of medications to patients through utilization of barcode scanning.
Analysis: Post-evaluation of baseline metrics, a re-competency program for all existing nursing staff was developed to include skills return demonstration, problem-solving strategies on equipment, processes for reporting equipment, medications that do not scan, or workflow impediments. This education was integrated into the new-hire orientation for all oncoming staff. Identification of barriers and gaps led to process improvement changes and communication to nursing staff that did not adhere to workflows. Monthly metrics were presented to ensure constant feedback. Ongoing issues were discussed in a governance structure with pharmacy and nursing operations to create sustainability in the project.
Outcomes: Ambulatory care nurses have achieved and maintained compliance >95% for medication and vaccination administration from August 2021 to March 2023. Medication administration safety practices are adhered in the outpatient setting and continue to improve the patient experience and safety in a fast-paced environment.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Tags:
education
nursing professional development
mobile skills lab
clinical training
innovative strategies
Updated: 03/07/24
Welcome to our world! In our multi-specialty, multi-site, ambulatory care arm of a large academic healthcare enterprise, we were presented with a unique nursing professional development opportunity. In the acute care environment, onsite centralization of educational initiatives and annual competency validation serves to bring the program as close to the learner as possible. Challenges in the ambulatory care world include widespread geography, fewer clinical staff members in given locations, lack of site-based clinical leaders and educators, with an underappreciation of the essentiality of continued education and training for clinical staff.
How can we reach, and teach, our ambulatory care clinical staff who are physically located at over 320 practice sites, across a rapidly expanding footprint? Our answer is twofold: by offering a clinical skills lab and by strengthening the presence of nursing professional development in all geographic regions. Clinical skills lab is a venue where we welcome multiple clinical disciplines, including professional nursing and patient facing ancillary staff. We offer live education sessions led by registered nurse and nurse practitioner instructors who hold expertise in ambulatory care nursing. Curriculum is updated annually and chosen through a variety of methods including internal and external quality findings, regulatory requirements, and updates in practice and technology. Feedback is incorporated from learning needs assessments as well as post-participant surveys.
This presentation will review existing trends and solutions in nursing professional development in ambulatory care settings. We will discuss barriers to the realization of comprehensive clinical education and provide insight into strategies for mitigation. We will share our process in introducing the roles of a director of nursing professional practice and education and clinical operations team in the ambulatory care arena, along with the many benefits of this structure. We will present pre-and post-data from participant surveys that will highlight the impact of a clinical skills lab. Lastly, we will outline the development of our mobile skills lab offering, Skills Lab: On-The-Go, and how this innovation has expanded our bandwidth in bringing hands-on clinical skills curriculum into the hands of the learner. Objectives are that learners will identify 1-2 actionable strategies to bring consistent, quality education and training to all ambulatory care clinical staff and choose 1-2 barriers where they can make an impact.
How can we reach, and teach, our ambulatory care clinical staff who are physically located at over 320 practice sites, across a rapidly expanding footprint? Our answer is twofold: by offering a clinical skills lab and by strengthening the presence of nursing professional development in all geographic regions. Clinical skills lab is a venue where we welcome multiple clinical disciplines, including professional nursing and patient facing ancillary staff. We offer live education sessions led by registered nurse and nurse practitioner instructors who hold expertise in ambulatory care nursing. Curriculum is updated annually and chosen through a variety of methods including internal and external quality findings, regulatory requirements, and updates in practice and technology. Feedback is incorporated from learning needs assessments as well as post-participant surveys.
This presentation will review existing trends and solutions in nursing professional development in ambulatory care settings. We will discuss barriers to the realization of comprehensive clinical education and provide insight into strategies for mitigation. We will share our process in introducing the roles of a director of nursing professional practice and education and clinical operations team in the ambulatory care arena, along with the many benefits of this structure. We will present pre-and post-data from participant surveys that will highlight the impact of a clinical skills lab. Lastly, we will outline the development of our mobile skills lab offering, Skills Lab: On-The-Go, and how this innovation has expanded our bandwidth in bringing hands-on clinical skills curriculum into the hands of the learner. Objectives are that learners will identify 1-2 actionable strategies to bring consistent, quality education and training to all ambulatory care clinical staff and choose 1-2 barriers where they can make an impact.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/07/24
Our health system, like many others, has been compelled to prioritize our workforce’s well-being due to the rise in burnout as experienced across the industry. Impacted by the pandemic, much of the burnout in ambulatory care is related to increased demand for outpatient care. With a focus on clinician efficiency and streamlining workflows for providers, there is more reliance on ambulatory care nurses to help tackle growing outpatient care needs. The intensified need for telephone triage and asynchronous care highlighted a training gap for our nurses transitioning to ambulatory care. We saw this as an opportunity to support new hire nurses with a high-value, standalone clinical orientation targeting content specific to ambulatory care core competencies. This session highlights our innovative approach to training redesign to meet the needs of our nurses.
Leveraging a multidisciplinary team, we designed a new and comprehensive orientation curriculum. To ensure high value, a needs assessment was conducted surveying ambulatory care nursing staff and nurse managers. Baseline perceived value of the existing curriculum was also measured. We received responses from over 220 nurses (roughly 33% of recipients). The content topics in greatest demand from front-line staff were identified as EHR inbox management, care coordination, and telephone triage. Of note, this content had not previously been included in our orientation and is typically not part of pre-licensure academic nursing programs.
In alignment with our values as a Magnet-designated facility, workgroups including ambulatory care front-line nurses, managers, clinical educators, nurse informaticists, and EHR trainers were convened to craft a curriculum using scenario-based training to teach the high-impact skills requested by our nursing workforce. Foundationally based in the AAACN core curriculum, we launched our new orientation content in January 2023 and immediately embarked upon rapid continuous improvement cycles. Feedback is evaluated from each cohort and content continues to be adjusted as needed.
Just six months into deployment, perceived value has increased 30% over baseline. In addition to increased perceived value, qualitative data consistently indicates that participants are better prepared to confidently practice in ambulatory care clinics. Cohort feedback also regularly requests additional time in scenario-based training.
We continue to iterate the program based on our foundational principles of leveraging the AAACN core curriculum, considering direct nurse feedback, and multidisciplinary team collaboration. The program working group is also evaluating options to offer this content to existing ambulatory care nurses who may have never received this vital training.
Learning outcomes: 1) Demonstrate the importance of staff feedback in the development of a training redesign that meets the needs of unique clinical workflows. 2) Demonstrate the value of an innovative approach incorporating ambulatory care core competency focused training into nursing clinical orientation.
Leveraging a multidisciplinary team, we designed a new and comprehensive orientation curriculum. To ensure high value, a needs assessment was conducted surveying ambulatory care nursing staff and nurse managers. Baseline perceived value of the existing curriculum was also measured. We received responses from over 220 nurses (roughly 33% of recipients). The content topics in greatest demand from front-line staff were identified as EHR inbox management, care coordination, and telephone triage. Of note, this content had not previously been included in our orientation and is typically not part of pre-licensure academic nursing programs.
In alignment with our values as a Magnet-designated facility, workgroups including ambulatory care front-line nurses, managers, clinical educators, nurse informaticists, and EHR trainers were convened to craft a curriculum using scenario-based training to teach the high-impact skills requested by our nursing workforce. Foundationally based in the AAACN core curriculum, we launched our new orientation content in January 2023 and immediately embarked upon rapid continuous improvement cycles. Feedback is evaluated from each cohort and content continues to be adjusted as needed.
Just six months into deployment, perceived value has increased 30% over baseline. In addition to increased perceived value, qualitative data consistently indicates that participants are better prepared to confidently practice in ambulatory care clinics. Cohort feedback also regularly requests additional time in scenario-based training.
We continue to iterate the program based on our foundational principles of leveraging the AAACN core curriculum, considering direct nurse feedback, and multidisciplinary team collaboration. The program working group is also evaluating options to offer this content to existing ambulatory care nurses who may have never received this vital training.
Learning outcomes: 1) Demonstrate the importance of staff feedback in the development of a training redesign that meets the needs of unique clinical workflows. 2) Demonstrate the value of an innovative approach incorporating ambulatory care core competency focused training into nursing clinical orientation.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Mildred Sattler, DNP, MSN, RN, CCRN, Corporate Director of Nurse Retention and Career Development, Emory Healthcare
Tags:
professional development
Updated: 03/07/24
Purpose: Using human-centered leadership dimension and attributes, ambulatory care nurse leaders developed professional development activities and created a culture of innovative exemplary professional practice. The creativities leveraged professional practice and individual growth, nurse peer mentoring, and a clinical ladder program for registered nurses (RNs), resulting in significant outcomes over a five-year span.
Relevance/significance: Nurse leaders remain challenged during the COVID-19 pandemic to keep nurses engaged while working at the bedside. Elements of the human-centered leadership model of the motivator, coach, mentor, architect, and advocate providing a caring environment that nurtures the nursing workforce through being kind and genuine and building relationships.
Strategy/implementation methods: Strategies were developed and implemented thoroughly, reviewing the literature on professional development, peer mentoring, and progression plans for nurses. These strategies included individual meetings, caring relationship building, webinars, retreats, workshops, small task forces, peer mentor program extension, leadership development and education, clinical ladder evaluation, and expansion. Nurse leaders were mindful and empathetic for nurses to advance on the clinical ladder structure. Nurse leaders developed and redesigned the clinical ladder criteria, checklist, nursing webpage, and career development goal planning forms. Front-line nurses provided feedback to nurse leaders on learning electives that they felt were important to their professional practice. Nurse leaders took this feedback and created a significant list of electives that were added to the nurse's achievements and also included the front-line nurses to serve as clinical ladder champions.
Evaluation/outcomes/research: Through the development of a nurse-centered professional clinical practice ladder, nurse leaders created a culture where professional development is all about the nurse. Over 54 clinical ladder electives are available for nurses. Additional professional development activities were created for nurses to earn two electives. In addition, nurses had the opportunity for a retention elective. Quarterly clinical ladder retreats were hosted. These retreats created opportunities for professional development, as well as opportunities for personal and professional connections. Nurse leaders found value in providing in-person and virtual workshops and monthly twice-a-day webinars for the nurses to attend. A total of 205 nurses advanced on the clinical ladder from 2018-2023. Since being introduced in 2018, there has been a 44.7% increase in ambulatory care nurses who advanced on the clinical ladder over a five-year span. In addition, the nurse peer mentoring program was extended and was offered to LPNs and medical assistants; 89% completed the program in the fiscal year 2021-2022, 73.6% met a SMART goal, and the program had a 97% nurse retention rate. Incidentally, we learned that the higher the percentage of nurses who advanced on the clinical ladder in several of our ambulatory care clinic settings, the lower the nurse bedside turnover rate for that specific clinic.
Conclusion: Using a human-centered leadership approach, nurse leaders reflected upon their self-awareness to find creative ways to help nurses stay engaged and appreciated. Nurse leaders created engagement and professional value through a variety of consciousness of others and synergistic strategies such as professional development, coaching, mentoring, self-reflection, humble inquiry, and kindness.
Relevance/significance: Nurse leaders remain challenged during the COVID-19 pandemic to keep nurses engaged while working at the bedside. Elements of the human-centered leadership model of the motivator, coach, mentor, architect, and advocate providing a caring environment that nurtures the nursing workforce through being kind and genuine and building relationships.
Strategy/implementation methods: Strategies were developed and implemented thoroughly, reviewing the literature on professional development, peer mentoring, and progression plans for nurses. These strategies included individual meetings, caring relationship building, webinars, retreats, workshops, small task forces, peer mentor program extension, leadership development and education, clinical ladder evaluation, and expansion. Nurse leaders were mindful and empathetic for nurses to advance on the clinical ladder structure. Nurse leaders developed and redesigned the clinical ladder criteria, checklist, nursing webpage, and career development goal planning forms. Front-line nurses provided feedback to nurse leaders on learning electives that they felt were important to their professional practice. Nurse leaders took this feedback and created a significant list of electives that were added to the nurse's achievements and also included the front-line nurses to serve as clinical ladder champions.
Evaluation/outcomes/research: Through the development of a nurse-centered professional clinical practice ladder, nurse leaders created a culture where professional development is all about the nurse. Over 54 clinical ladder electives are available for nurses. Additional professional development activities were created for nurses to earn two electives. In addition, nurses had the opportunity for a retention elective. Quarterly clinical ladder retreats were hosted. These retreats created opportunities for professional development, as well as opportunities for personal and professional connections. Nurse leaders found value in providing in-person and virtual workshops and monthly twice-a-day webinars for the nurses to attend. A total of 205 nurses advanced on the clinical ladder from 2018-2023. Since being introduced in 2018, there has been a 44.7% increase in ambulatory care nurses who advanced on the clinical ladder over a five-year span. In addition, the nurse peer mentoring program was extended and was offered to LPNs and medical assistants; 89% completed the program in the fiscal year 2021-2022, 73.6% met a SMART goal, and the program had a 97% nurse retention rate. Incidentally, we learned that the higher the percentage of nurses who advanced on the clinical ladder in several of our ambulatory care clinic settings, the lower the nurse bedside turnover rate for that specific clinic.
Conclusion: Using a human-centered leadership approach, nurse leaders reflected upon their self-awareness to find creative ways to help nurses stay engaged and appreciated. Nurse leaders created engagement and professional value through a variety of consciousness of others and synergistic strategies such as professional development, coaching, mentoring, self-reflection, humble inquiry, and kindness.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/28/24
Purpose: The purpose of this initiative was to engage leaders and re-establish performance expectations related to medication administration and specimen labeling after the organization identified an increase in the number of near-miss and patient safety events (SE) in fiscal year (FY) 23. Using the electronic safety event reporting system, ambulatory care clinical quality consultants (CQC) identified that there was a 1% increase in the amount of medication and specimen errors between FY22 & FY23; this did not meet the organizational goal for FY23 (10% decrease in the number of associated SEs). Reduction of safety events has been found to be positively related to effective leadership styles. CQCs identified a need to provide education to ambulatory care clinical leaders due to the increase of events that were affecting the quality of patient care. The CQCs designed and implemented a clinical competency leader course to ensure leaders were aware of the correct processes for medication administration and specimen collection and to enhance leadership confidence.
Description: CQCs conducted a gap analysis that led to the identified need for a clinical competency leader course. Clinical competency courses have been shown to enhance awareness of safety and quality outcomes for staff. Root cause analysis (RCA) of SEs identified common themes: incorrect medication given, no order placed in the electronic medical record (EMR) for a medication, and specimen collection errors (mismatched specimen labels, incorrect site marked on label, specimen misplaced and unable to be analyzed). With data showing an increase in SEs related to these themes, CQCs created a standardized competency assessment course for ambulatory care clinical leaders. The course combined didactic and hands-on learning in the simulation lab and allowed participants to roleplay various scenarios. The course emphasized the importance of leaders setting expectations and working collaboratively with staff to identify gaps in clinical processes that lead to SEs.
Evaluation: The course has resulted in increased leader confidence and awareness of SE reporting. Additionally, the course has fostered an environment of collaboration between leaders in various clinical areas. There is predicted to be a 5% decrease in related SEs for FY24 because of this course.
Description: CQCs conducted a gap analysis that led to the identified need for a clinical competency leader course. Clinical competency courses have been shown to enhance awareness of safety and quality outcomes for staff. Root cause analysis (RCA) of SEs identified common themes: incorrect medication given, no order placed in the electronic medical record (EMR) for a medication, and specimen collection errors (mismatched specimen labels, incorrect site marked on label, specimen misplaced and unable to be analyzed). With data showing an increase in SEs related to these themes, CQCs created a standardized competency assessment course for ambulatory care clinical leaders. The course combined didactic and hands-on learning in the simulation lab and allowed participants to roleplay various scenarios. The course emphasized the importance of leaders setting expectations and working collaboratively with staff to identify gaps in clinical processes that lead to SEs.
Evaluation: The course has resulted in increased leader confidence and awareness of SE reporting. Additionally, the course has fostered an environment of collaboration between leaders in various clinical areas. There is predicted to be a 5% decrease in related SEs for FY24 because of this course.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/28/24
Nurse leaders have forewarned impending nursing shortages for the past two decades due to an aging workforce and the decline in individuals choosing the nursing profession. The past two years of the COVID-19 pandemic have exacerbated the healthcare workforce challenges, including accelerating retirements and burnout. In a nursing workforce update, nursing turnover was at an average rate of 27.1% in 2021. Registered nurse vacancy rates are trending at 17%, increasing costs associated with temporary labor, nurse recruitment, and training. Not only is this common to nursing but also in roles that support nurses' work and patient care. Like other healthcare organizations, our organization has experienced an increased turnover of clinical positions and shirking recruitment pools. Therefore, clinical care will require support from other team members, such as medical assistants, to meet the demand.
Background: The ambulatory care clinics are part of an academic health system in the southeast region of the United States, with over 200 clinics providing primary care, specialty care, and outpatient procedures. The ambulatory care clinical operation offers under 2 million visits annually, responds to over 18 million patient-related messages, and refills more than 200,000 prescriptions. The system employs registered nurses, licensed practical nurses, and medical assistants to provide clinical care in collaboration with physicians and advanced practice clinicians. However, the role of the MA in the organization is limited to their qualified skill set.
Intervention: Nursing education sent a needs assessment survey to 375 MAs. The responses from the MAs were they felt they needed to integrate into the healthcare team, their voice needed to be heard by the leaders, and their job needed to be more significant. Based on the feedback, an MA council was developed to address job dissatisfaction and provide the MAs with peer collaboration and leadership presence. Additionally, nurse leaders, nursing education, and MAs developed a committee to explore retention strategies, evaluate current MA skills, and identify opportunities to expand practice. As part of the committee's work, the committee sent a survey to nurse leaders to determine additional skills needed for their clinical areas and ways to improve the MA orientation process.
Outcomes: As the MA-specific new hire orientation was developing, the organization needed to prepare the current MA staff by holding an MA expo and train the trainer event. The current MAs were incorporated into the expo as they will serve as preceptors and mentors to the new hires that attend the MA-specific orientation. The expo introduced new MA skills for training and a virtual professionalism course. The MA orientation consisted of a two-day training course based on identified gaps in knowledge and skills taught through didactic, large group discussion, hands-on skills, and simulation practices. The simulation portion allows the new hire to get comfortable with scenarios within the clinic environment. Investment in robust training for MAs will ensure safe clinical practice while partnering with the healthcare team to meet staffing demands.
Background: The ambulatory care clinics are part of an academic health system in the southeast region of the United States, with over 200 clinics providing primary care, specialty care, and outpatient procedures. The ambulatory care clinical operation offers under 2 million visits annually, responds to over 18 million patient-related messages, and refills more than 200,000 prescriptions. The system employs registered nurses, licensed practical nurses, and medical assistants to provide clinical care in collaboration with physicians and advanced practice clinicians. However, the role of the MA in the organization is limited to their qualified skill set.
Intervention: Nursing education sent a needs assessment survey to 375 MAs. The responses from the MAs were they felt they needed to integrate into the healthcare team, their voice needed to be heard by the leaders, and their job needed to be more significant. Based on the feedback, an MA council was developed to address job dissatisfaction and provide the MAs with peer collaboration and leadership presence. Additionally, nurse leaders, nursing education, and MAs developed a committee to explore retention strategies, evaluate current MA skills, and identify opportunities to expand practice. As part of the committee's work, the committee sent a survey to nurse leaders to determine additional skills needed for their clinical areas and ways to improve the MA orientation process.
Outcomes: As the MA-specific new hire orientation was developing, the organization needed to prepare the current MA staff by holding an MA expo and train the trainer event. The current MAs were incorporated into the expo as they will serve as preceptors and mentors to the new hires that attend the MA-specific orientation. The expo introduced new MA skills for training and a virtual professionalism course. The MA orientation consisted of a two-day training course based on identified gaps in knowledge and skills taught through didactic, large group discussion, hands-on skills, and simulation practices. The simulation portion allows the new hire to get comfortable with scenarios within the clinic environment. Investment in robust training for MAs will ensure safe clinical practice while partnering with the healthcare team to meet staffing demands.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/07/24
Conference attendees will be able to design and implement a specialty ambulatory care curriculum as part of the NGRNs transition to practice program. The purpose of the project is to develop and evaluate specialty ambulatory care curriculum for newly graduated registered nurses (NGRN) using the AAACN scope and standards in a complex 300+ multi-specialty ambulatory care setting at a large academic level-1 trauma medical center.
Nurses in the ambulatory care setting are managing chronic complex diseases that require multidimensional clinical judgment skills. NGRNs are not prepared to work in the ambulatory care setting due to a lack of ambulatory care experience during nursing school. By implementing a specialty ambulatory care curriculum track as part of an accredited transition to practice program, the confidence and competence of the nurse’s knowledge, skills, and attitude increase, reducing the education-to-practice gap. Multi-specialty didactic curriculum, competency tools, and progression plans were developed using QSEN competencies and AAACN Scope and Standards. Program designed to provide experiential learning across the continuum of care that prepares NGRNs to practice at the top of their license and provide clinic leadership for an interdisciplinary team and holistic care to a diverse patient population. NGRN candidates were selected based on the clinic setting, staffing model, candidates’ career interests, and nursing/operational leader approval. The candidates had CMA or LVN ambulatory care experience before transitioning into the NGRN role. Data collection: retention and Casey-Fink Experience survey.
To meet the needs of the diverse patient population and provide care across the continuum, the NGRN focused on competencies in the following specialties: cardiology, pain management, neurology, urology, OB/GYN, pulmonary, GI, wound care, family medicine, pediatrics, hospice/palliative, infectious disease, nephrology, and endocrinology. Seven NGRNs have participated to date. Completion of the clinical immersion phase of the transition-to-practice program is 100% with a 1-year retention of 100%. Casey-Fink experience survey results above the benchmark in autonomy and advocacy, collaboration, unit engagement, unit leadership, and satisfaction and commitment. Standardized EBP program provides a career pathway for clinical staff in the ambulatory care setting and pursuing a BSN nursing degree. This program can be replicated in other organizations seeking to establish a transition to practice program for NGRNs in the ambulatory care setting.
Nurses in the ambulatory care setting are managing chronic complex diseases that require multidimensional clinical judgment skills. NGRNs are not prepared to work in the ambulatory care setting due to a lack of ambulatory care experience during nursing school. By implementing a specialty ambulatory care curriculum track as part of an accredited transition to practice program, the confidence and competence of the nurse’s knowledge, skills, and attitude increase, reducing the education-to-practice gap. Multi-specialty didactic curriculum, competency tools, and progression plans were developed using QSEN competencies and AAACN Scope and Standards. Program designed to provide experiential learning across the continuum of care that prepares NGRNs to practice at the top of their license and provide clinic leadership for an interdisciplinary team and holistic care to a diverse patient population. NGRN candidates were selected based on the clinic setting, staffing model, candidates’ career interests, and nursing/operational leader approval. The candidates had CMA or LVN ambulatory care experience before transitioning into the NGRN role. Data collection: retention and Casey-Fink Experience survey.
To meet the needs of the diverse patient population and provide care across the continuum, the NGRN focused on competencies in the following specialties: cardiology, pain management, neurology, urology, OB/GYN, pulmonary, GI, wound care, family medicine, pediatrics, hospice/palliative, infectious disease, nephrology, and endocrinology. Seven NGRNs have participated to date. Completion of the clinical immersion phase of the transition-to-practice program is 100% with a 1-year retention of 100%. Casey-Fink experience survey results above the benchmark in autonomy and advocacy, collaboration, unit engagement, unit leadership, and satisfaction and commitment. Standardized EBP program provides a career pathway for clinical staff in the ambulatory care setting and pursuing a BSN nursing degree. This program can be replicated in other organizations seeking to establish a transition to practice program for NGRNs in the ambulatory care setting.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
