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P067 - Managing the Revolving Door: Orientation and Retention Strategies for an Ambulatory Care Subspecialty Clinic
Monica Banes, MSN, RN, CPN, Director for Ambulatory Care Services, Texas Children's Hospital    |     Sherry Grant, MSN, RN
Tags: nurse retention nurse orientation turnover costs

Updated: 03/07/24
Learning objectives: Analyze barriers/challenges and assemble a structured orientation to transition to practice for nurses in an ambulatory care setting.

Purpose: Proper onboarding and orientation are essential to building and retaining employees, as well as high-performing teams. The ambulatory care subspecialty clinic staff members are challenged with managing specific health concerns and conditions for the pediatric patients who present to the clinics daily. As a result, staff members working in these clinics require proper integration and transition into practice. Allen (2016) states, “Creating a core RN orientation program template is paramount for the transition of the RN to the ambulatory setting.” Therefore, a structured onboarding and orientation process is imperative for new, transfer, and contract employees working in the ambulatory care setting.

Description: Due to a turnover rate of 35.71% in the first quarter of fiscal year 2023, it was identified that the onboarding and orientation process was inconsistent and unstructured. In collaborating with the nursing leadership team, clinical educator, and a new position titled nurse retention specialist, we explored options that would enhance the employees’ onboarding and orientation experience. This caused an examination of how effective the orientation and onboarding program was in retaining talent in this outpatient department.

Outcomes: Studies demonstrate that a well-designed onboarding and orientation program can dramatically improve readiness, performance, and retention. Strategies used include the implementation of structure and process changes, such as a single centralized education resource for onboarding oversight, manager/leader cascading responsibilities, structured process map for onboarding and orientation, and use of interdisciplinary content has resulted in positive outcomes. Additionally, new focused orientation competencies include defining a healthy and safe work environment, role ambiguity and socialization while also handling role conflict, enhancing the Magnet® connection, building upon the management link to practice, and clarification of job expectations.

With every percent change in RN turnover, organizations can save approximately $380,600 per year. The orientation restructure proved a positive influence on the retention financial metric significantly. We anticipate turnover will decline allowing for the improvement of the bottom line, a more connected culture among clinic staff, and a seamless onboarding experience. Since January 2023, there have been zero nurse terminations in the ambulatory care subspecialty clinic, furthering the stabilization and validating the new processes. As other elements of the onboarding and orientation process are addressed, the hope is to sustain the program and transform and enhance the ambulatory care staff’s experience, knowledge, and skill during the onboarding and orientation process.

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.

P069 - Benefit of Ambulatory Care RN Educators Supporting the Psychometric Transition of Ambulatory Care Residents in an Inpatient-Focused Program
Kimberly Nelson, MSN, RNC-OB
Tags: transition to practice resident RN resident

Updated: 03/07/24
At a large academic medical center, an ambulatory care RN residency track within the organizational transition-to-practice program was created. The transition-to-practice program is a 12-month program accredited through the ANCC practice transition accreditation program. The program is designed by the clinical education and professional development (CEPD) team to introduce graduate RNs to the ambulatory care specialty. Following the 2017 AAACN residency program recommendations, CEPD has developed a solid team to help the psychometric confidence of the graduate nurses transitioning to the ambulatory care specialty.

In addition to the professional development offerings from the transition practice team, the ambulatory care track provides a skills session and six didactic sessions instructed by CEPD nurse educators guided by the AAACN content, including an introduction to ambulatory care, scope and standards of ambulatory care nursing, care coordination, patient education, telehealth and triage, and patient-centered care. The RN residents are given critical-thinking assignments and online education modules on a weekly or bi-weekly basis that directly correlate to the ambulatory care didactic session to increase their knowledge and confidence in caring for their patient population.

A literature review reveals that emotional exhaustion, workload, and stress for new graduate nurses were initially high, directly correlating to decreasing when the graduate nurse job satisfaction increased. Identifying factors on the Casey-Fink survey with previous cohorts, ambulatory care RN residents specifically mentioned that the transition-to-practice program is not geared towards the ambulatory care setting. Is this adding additional stress and role transition difficulties for ambulatory care RN residents?

A revamp of the ambulatory care track program provides a dedicated master’s-prepared nurse facilitator and co-facilitator. The organization has over 95 clinics, each with dedicated nurse educators. This provides an additional layer of educational support for the residents. The facilitators begin supportive efforts during the interview phase and communicate consistently with RN residents until the hire date. Facilitators also provide ongoing mentorship, competency validation, and transitional support throughout the didactic and clinical year-long program. Additionally, the facilitators meet with RN residents in a group setting for the didactic content and offer one-on-one touchpoint every 3 months until completion of the program. Communication with program leadership includes monthly meetings to discuss progression and to identify educational gaps.

Our goal is to compare the Casey-Fink data from previous cohorts in the categories of support, stress encountered, communication/leadership, and job satisfaction to see if the efforts made by the ambulatory care track facilitators impact support, role transition, overall satisfaction with future cohorts.

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.

P070 - Creating a Pathway to Role Optimization with Lidocaine Administration
Nicola Anderson, MSN, RN, AMB-BC
Tags: medical assistant dermatology lidocaine role optimization

Updated: 03/28/24
Dermatology is a specialty that focuses on diagnosing and treating skin conditions. According to the Academic Alliance in Dermatology (AAD), there are 4 types of dermatology; derma-pathology, pediatric dermatology, Mohs surgery, and cosmetic dermatology. Specialized procedures are done to aid patients in overcoming various types of skin conditions, such as acne, eczema, psoriasis, autoimmune disorders and skin cancers, which requires specialized diagnostic procedures. Treatment of these conditions often requires the use of local anesthetics, i.e. lidocaine. Use of lidocaine is crucial to establishing a state of numbness to the nerve endings without causing unconsciousness. Most dermatological procedures are done in an outpatient setting, that is staffed with medical assistants (MAs) supporting the clinical team.
A large academic medical center in Georgia treats roughly 32, 000 patients per year with various skin conditions. Using PDSA methodology an opportunity was identified for the medical assistant (MA) to administer dermal lidocaine utilizing provider orders. A comprehensive guideline in the form of standard work was created to include physician orders, education, training, and competency checklist. Over the duration of a year, research and collaboration was conducted to elevate the role of the MA, which included education, training, and assurance of competency in safety administering dermal lidocaine. Elevating the role of the MA to safely administer dermal lidocaine to assist the provider in anesthetizing the patient allowed for a quicker and more efficient treatment plan for patients. By creating standard work and establishing a detailed training program with competencies, the providers were able to efficiently care for patients within 15- to 20-minute appointment slots. This quick turnover of appointments depends on the speed and efficiency of the MAs to conduct clinical intake and vital signs and prepare patients for their procedures.
The Georgia regulations for MAs (section § 43-34-44) outline the role of the medical assistant, stating that a physician may delegate a task to the MA who has been trained, deemed competent, and meets the expectations of their respective organization. Using the standard work with competency checklists created, MAs were educated and trained on dermal lidocaine injection techniques to safely inject the patient. After three documented competencies under the guidance of a physician, the MA was deemed competent by the physician to inject lidocaine prior to a dermatological procedure. As a result of this work, organizational policy was changed to reflect that dermatology MAs would be able to practice at an optimal level of their scope of responsibility with in the standard work and competency. This new competency introduced a change in scope of responsibility and ultimately changed the dermatology MA titles to medical assistant proceduralist.
Creating a pathway to role optimization with lidocaine administration has improved efficiency in dermatology to allow for patients to be seen timely, which adheres to the division’s scheduling process of patients to be seen in 15- to 20-minute appointment time slots. Additional anectodical comments from the MAs include role/job satisfaction.

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.

P071 - Nursing Roles in Outpatient Substance Use Disorder Treatment: Be Optimistic - Recovery is Possible
Brenda Luther, PhD, RN, Professor, College of Nursing, University of Utah
Tags: substance use disorder

Updated: 03/21/24
Purpose: Nurses in primary care have an emerging and leading role in caring for patients with substance use disorder (SUD). 10% of US adults have a SUD some time in their lifetime and 75% report NOT receiving any form of treatment. Lack of access and delayed access are cited as the first barriers to providing care for SUD. Nurses are key clinicians to identify and treat SUD in an office-based addiction treatment (OBAT) model. Nurses also play an important role in identification of social determinants of health factors that can participate in SUD. OBAT programs improve SUD outcomes such as improving access to first-step treatment such as buprenorphine, providing education and support that reduce overdose deaths, improving engagement in peer-support programs, and increasing patient and family’s knowledge of coping and harm-reduction. Nursing skills and competencies directed at SUD care are needed to expand the capacity of primary care settings to delivery this essential care.

Description: As the nurse's roles in SUD treatment are expanding and becoming more defined, this session will present current evidence on the pathology of addiction, current treatment modalities, team-based models of care for SUD and team preparation, as well as the specific nurses’ role. OBAT programs in ambulatory care require nurses to organize the interprofessional team to identify key screening points, develop approved policies and procedures describing all roles of the team, develop protocols to guide care and treatment, and develop necessary community partners to support patients and families.

Evaluation: This evidence-based presentation will guide and support our ambulatory care nursing workforce in the steps, competencies, and roles of nurses in SUD OBAT programs. Upon completion of the presentation, the audience will be able to identify incidence/prevalence of SUD, describe the nurse’s role in SUD OBAT programs, identify key steps of OBAT programs (i.e*.,: screening, consenting, induction and stabilization, billing), and identify and evaluate key nurse sensitive indicators (NSI) and overall outcomes an SUD protocol in an OBAT program.

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.

P072 - Using the Annual Wellness Visit to Generate Revenue and Improve Patient Care
Author Eileen M. Esposito, DNP, RN, AMB-BC, DipACLM, CPHQ, Senior Healthcare Executive
Tags: improved outcomes annual wellness visit RN-patient engagement top-of-license revenue generating

Updated: 03/21/24

Updated: 03/21/24
The annual wellness visit (AWV) is a specific wellness and prevention-focused visit for Medicare beneficiaries that can be performed by registered nurses. The purpose of the visit is to engage Medicare beneficiaries as active participants in their health and to provide them with an annual plan for wellness and chronic disease management including recommendations for routine preventive screening tests, e.g. mammograms. This study details the creation of a nursing team who provided AWV via remote/telehealth methodologies over a three-year period to Medicare fee-for-service beneficiaries in an accountable care organization (ACO). The outcomes achieved include provision of over 16,000 AWVs per year. These visits generated over $2 million annually and improved quality scores significantly. The improved quality scores were the result of closed gaps in care and generated an additional $1.1 million in revenue and ultimately resulted in shared savings payment of $31 million to the ACO for the 3 years of this study.

Purpose: To determine if RNs working at the top-of-license could improve patient outcomes and generate revenue by performing the CMS annual wellness visit to Medicare fee-for-service beneficiaries in the ACO.

Description: A team of registered nurses was assembled and tasked with engaging patients in their preventive healthcare plan. The nurses were trained in motivational interviewing for patient engagement and adult health screenings were reviewed. They used a structured risk assessment and formatted templates to document their interactions with the beneficiaries.

Evaluation/outcome: Ten RNs collaborated with the primary care providers to provide up to 16,000 AWV annually. The visits generated over $2 million revenue each year and significantly improved quality scores in the ACO. Improved quality scores are evidence of closing gaps in care and ensuring beneficiaries receive the appropriate preventive care they need. The improved quality scores resulted in enhanced Medicare part-B revenue of over $1 million annually as well as achieving shared savings payments of over $31 million in 3 years.

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.

P073 - Crushing the Joint Commission Survey with Teamwork and Confidence!
Donna McCabe, BS, RN
Tags: accreditation teamwork survey regulatory Joint Commission readiness tracers

Updated: 03/07/24
Purpose: Our facility is a 1,000-bed academic medical center with around 1.5 million outpatient visits annually. This includes ~300,000 visits to community health centers serving low-income populations. Our institution is committed to consistently delivering the safest care possible to every patient. Ensuring excellent performance on The Joint Commission accreditation is a top priority and begins with an “excellence every day” attitude, ongoing evaluation, and continual improvement. Our aim is to improve ambulatory care patients’ care and outcomes and achieve excellent survey results through a multifaceted approach.

Learning objective: Participants will be able to identify strategies to enhance their readiness plans.

Description: Engaging all staff in continuous Joint Commission readiness has proven highly effective. We accomplish this through education, support, and hands-on experiences to encourage teamwork and foster shared responsibility for excellence. We conduct a thorough ongoing risk assessment considering past TJC results, data from other institutions, TJC briefings, NPSGs, new TJC standards, internal mock surveys, safety reporting, and other relevant metrics. A SAFER matrix assesses the scope and likelihood of harm, helps prioritize improvement efforts, and is shared broadly. Effective interdisciplinary tracers are the foundation of readiness. Using an institutionally developed app, tracers identify areas of strength and opportunity, and provide real-time non-punitive feedback and education. Our webinar series led by local experts (It Takes a Team: Promoting Excellence in Ambulatory Care) enhances knowledge about key standards: medication management/safety, teamwork, improving care, diversity, equity, leadership, safeguarding high-risk patients, safe environment, and workplace violence reduction.

Using this knowledge, staff survey their areas using an observation-based EOC weekly checklist to identify and address concerns and empower staff to collectively contribute to maintaining a safe, compliant environment. Keeping leadership informed about checklist results and any barriers identified fosters transparency, accountability, and proactive problem-solving. Highlights of additional resources/activities include: a high-priority leadership checklist for leaders/clinicians; ambulatory care-focused resource webpages including toolkits and webinar recordings; data easily accessible via dashboards; monthly town halls by the compliance department, open to all, sharing results and best practices; distribution of a clinical newsletter to approximately 5,000 ambulatory care employees; executive champions for most challenging standards; and excellence every day committee structure.
Evaluation/outcome: 2021: Webinar attendees reported increased confidence in Joint Commission readiness. Practices’ completion of EOC checklist was associated with a lack of negative survey findings. Excellent results on 2021 TJC survey. 2022: 158 ambulatory care/procedural tracers, with 90% meeting the passing threshold of 75%. 2023: Over 90% of practices surveyed met an increased threshold of 85%. TJC survey in fall.

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.

P074 - Using a Pictorial Mat to Improve Patient Knowledge and Confidence About Performing OPAT: A Quality Improvement Project
Jessica Davis, BSN, RN    |     Dimmi Jackson, BSN, RN
Tags: patient education outpatient parenteral antibiotic

Updated: 03/07/24
Background: The medical care of persons with chronic infection often involves the use of outpatient parenteral antibiotic therapy (OPAT). Benefits include significantly reduced hospitalization cost, days of hospitalization, and hospital-acquired infections, as well as improved quality of life. OPAT risks include increased incidence of vascular and antimicrobial complications. High-quality patient education has been found to be critical for high-quality OPAT programs in reducing risks.

Methods: This quality improvement (QI) project will utilize the plan-do-study-act (PDSA) cycle and a newly developed pictorial OPAT mat as an intervention to potentially improve patient education in our infectious disease clinic related to knowledge and confidence in performing OPAT.

Procedure:
Plan: Using a convenience sample, investigators will assess the patient’s self-rating of knowledge and confidence about their ability to perform OPAT using an investigator-developed, 14-item survey (OPAT knowledge and confidence scale [OKCS]). The sample will be divided into 2 groups: the standard care group (SC) (demonstration-return demonstration/teach-back) and the standard care + OPAT mat group (SC+OM) (demonstration-return demonstration/teach-back + OPAT mat).
Do (data collection): In the first month of the study, an investigator provided SC to all hospitalized patients who consented to participate. All consenting participants received SC+OM in the second month. All participants completed a REDCap electronic survey version of the OKCS at the time of consent, after teaching, and before hospital discharge. This project was reviewed and approved by a university-based institutional review board.
Study (data analysis): Frequencies were used to examine group differences. The overall mean score for the OKCS was 3.67/5.0. 59 subjects consented to participate in this project. 33 participants were in the SC group and 26 participants comprised the SC+OM group. The overall mean score for the OKCS was 3.45 for the SC group and 3.89 for the SC+OM group. Participants in the SC+OM group had higher scores on 11/14 items on the OKCS. The item with the lowest score in both groups was Q6: I know what to do if the medication administration line is sluggish or hard to flush (SC= 3.00 vs SC+OM= 3.42).
Act (conclusions): Participants demonstrated greater knowledge and confidence in performing OPAT when the OPAT mat was added to our standard teaching practices. Results indicate a need to particularly focus teaching on troubleshooting potential problems that may occur in OPAT administration.

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.

P075 - Evaluation of Care Coordination Review Teams
Julie Alban, DNP, MPH, RN-BC
Tags: care coordination evaluation complex patients

Updated: 03/07/24
Purpose: Care coordination and integrated case management (CCICM) is a Veterans Health Administration (VHA) practice framework that addresses the fragmentation, variation, and gaps in care by introducing a system-wide, integrated care coordination framework. An integral element of this framework is the deployment of the care coordination review team (CCRT), which is made up of interprofessional team members who review veterans with complex care needs. The CCRT members determine and assign a lead coordinator (LC) who is a readily accessible and clearly identifiable point of contact for a veteran, their caregiver, and care team members. Evaluation of the CCRT review process was created to provide feedback to facilities regarding CCRT implementation to ensure integration of communication, collaboration, and coordination for LC assignment for veterans with complex care coordination needs.

Description: The CCICM framework was deployed in October 2021 through a phased approach among 139 facilities across VHA. Care coordination is an essential component for effective holistic care within the largest integrated healthcare system in the United States. The framework includes five (5) milestones and 24 critical actions that need to be addressed for implementation. One of the critical actions of this framework includes the deployment of the CCRT which identifies and assigns a LC to veterans with complex care needs. The LC helps ensure the veteran’s care is coordinated across services and episodes of care. Having a LC who oversees care coordination and facilitates communication, reduces intervention duplication, and improves delivery of care. Evaluation of the CCRT implementation and LC assignment process was created using the plan-do-study-act (PDSA) model. In addition, Prosci change management tools were reviewed for the development of the evaluation process. In alignment with the high-reliability organization (HRO) pillar of continuous process improvement, the review process supported stakeholders with CCRT processes by providing feedback to ensure the integrity of the purpose and intent of this multifaceted critical action.

Evaluation/outcome: A standardized CCRT evaluation process was created to support stakeholders with implementation. The evaluation process was conducted among 11 sites that had CCRTs implemented. A total of 90 cases (146 observations) were reviewed by the evaluation team comprised of CCICM field consultants since the initiation of the process in June 2022 through June 2023. Trends regarding CCRT processes were identified, shared with end-users, and utilized to augment the implementation process. Feedback from stakeholders regarding the process indicated the following: the review was helpful in improving the CCRT process, review elements addressed pertinent CCRT critical actions, and changes to CCRT processes were implemented because of the reviews. Additionally, because of the evaluation process, the need to develop a CCRT toolkit was identified. In July 2023, another workgroup was established to develop a CCRT toolkit that included training and resources to further support CCRT implementation.

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.

P076 - The EBP Toolkit: More Tools than You Thought!
Margo Halm, PhD, RN, NEA-BC, FAAN, Nurse Scientist Consultant
Tags: evidence-based practice improvement self-efficacy implementation culture attitudesbeliefs knowledgeskills measurement

Updated: 03/07/24
Background: Evidence-based practice (EBP) is a cornerstone of safe, high-quality care. Many factors influence successful use of EBP, from clinician attitudes/beliefs, self-efficacy and knowledge/skills to contextual factors like unit/organizational culture. Based on a recent integrative review, this presentation will increase nurses understanding of valid and reliable EBP instruments so they can utilize these tools to advance critical EBP domains in their healthcare organizations and thereby improve health outcomes.

Methods: A systematic search of CINAHL, PubMed, EMBASE, Joanna Briggs and Cochrane Library was performed to acquire original research testing the reliability/validity of EBP nursing instruments. Key search terms included EBP, instruments, tools, nurses, beliefs, attitudes, self-efficacy, readiness, knowledge/skills, implementation, behaviors, leadership, and culture.

Results: Of 347 records, 50 instruments underwent at least one method of reliability or validity testing. Data extracted for each instrument included author, year, name, country, evaluation aim, conceptual base, item type, data collection method, scoring, psychometric properties, acceptability, feasibility, and readability. Most instruments were validated in English. Of all 50 instruments: Three measured attitudes/beliefs about one’s EBP ability or its value. Eight measured self-efficacy or confidence in one’s EBP ability or its expected outcomes. Ten measured knowledge/skills in EBP steps/components. Five measured implementation of evidence and how contextual factors hinder or facilitate it. Five measured EBP culture, such as perceptions of readiness, leadership or mentorship at the unit/organizational level. 19 measured >1 above EBP domains. Standards for content validity, construct validity and internal consistency were met for 70%, 62% and 94% of instruments, respectively. Limited testing was found for other types of validity, test-retest reliability, acceptability, feasibility, or responsivity/sensitivity and thus, represent gaps in psychometric validation. Less than 20% of instruments have been translated to other languages limiting their use to advance EBP worldwide.

Implications for practice: This collection of EBP instruments is a significant contribution to advancing EBP cultures. Nurses can utilize these tools in education and practice to shape necessary beliefs, knowledge/skills, and culture to globally support EBP in ambulatory care areas and the broader healthcare organization. These instruments can serve multiple purposes such as devising strategic plans and setting goals to build infrastructures that support EBP practice environments; acquiring resources (e.g., databases, librarians, advanced practice nurses) to support EBP cultures; examining beliefs, self-efficacy, and knowledge/skills to identify nurses’ professional development needs; investigating how often nurses apply EBP knowledge/skills to discover opportunities for coaching/mentoring; assessing barriers/facilitators to develop strategies to address contextual factors; and evaluating improvement in EBP domains after tailored interventions are implemented at the unit/division/organizational level.
Using these instruments in research is also imperative to advance the global EBP agenda. Comparative effectiveness research is vital to generate new knowledge about educational and system interventions that improve nurses’ beliefs and confidence in their knowledge/skills to routinely implement EBP in practice.

Conclusion: 82% of instruments met minimal psychometric standards. Expanding psychometric testing and utilizing validated EBP instruments in education, practice, and research will further the EBP movement to improve population health across the globe.

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.

P077 - Registered Nurse-Led Annual Wellness Visits in Rural Health Clinics: A Program Evaluation of a New Role
Tina C. Switzer, DNP, RN, CNL, Partnership Liaison, James Madison University
Tags: primary care preventive care annual wellness visit registered nurse rural health clinic

Updated: 03/07/24
Purpose: The purpose this program evaluation was to explore the outcomes of a registered nurse-led annual wellness visit (AWV) intervention on AWV completion numbers as well as preventive care gap closures after the introduction of two primary care RNs to five northwestern Virginia rural health clinics (RHCs) and initiation of an RN-led AWV pilot.

Background/significance: The passage of the Patient Portability and Affordable Care Act had a goal of increasing access for preventive care. The Medicare annual wellness visit has been a free yearly comprehensive preventive care opportunity for most Medicare beneficiaries since 2011. Because of the time-intensive nature of these visits, the overall national completion rate for them has been low as providers often perceive time and resource constraints. Registered nurses (RNs) have the skill set to complete these visits with minimal provider involvement. Rural residents often face healthcare access barriers and outcome disparities, and rural health clinics are a resource intended to increase access to health care in these disparate areas, but registered nurses are an underused resource in this setting. A literature review demonstrated an overall lack of studies on RN primary care roles. and no studies were found with a specific focus on these roles in federally designated rural health clinics.

Methods: This PRECEDE-PROCEED program evaluation examined the impact of RN-led AWVs on preventive care completion in 5 RHCs in northwestern Virginia.

Results: These visits increased access to primary care services while closing gaps in screening and preventive care including breast and colon cancer screenings with 66.7% and 45.8% completion rates after the visit. The visits also demonstrated emergency department encounters and hospital admission rates that had a statistically significantly lower rate than the 2019 Medicare local and national averages. Potential role sustainability was demonstrated with the new generated income (approximately $45,000 in 6 months) and productivity for the clinic.

Conclusions/implications: This program evaluation demonstrated an increase in patient access to preventive care services as well as helping to inform potential financial sustainability of the RN role in the rural health clinic care setting. Both the Institute for Healthcare Improvement and the Institute of Medicine’s Future of Nursing Report have compelled primary care redesign that focuses on continuity and care transitions across settings, preventive care, and the use of RNs at the top of scope practice to have an important role in this redesign. This evaluation was a means to explore patient and clinic outcomes from an RN-led, evidence-based intervention and serves as a foundational assessment to guide continued scholarly exploration of registered nursing interventions and care opportunities in various primary care settings.

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.

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