AAACN 50th Annual Conference 2025

P093 - Time to Mobilize in 2025

Rebecca Newman, MS, RN, CPN, Children's Hospital of Colorado, Registered Nurse | Leondra Weiss, MN, ARNP, FNP-BC, C-EFM, AMB-BC, Family Medicine ARNP, Sea Mar Community Health Center

Updated: 05/18/25

Purpose: The purpose of this survey was to better understand the knowledge and involvement in advocacy. The secondary aim was to capture the policy priorities of AAACN members.
Background: Ambulatory care nurses are in a unique position to address the increasing care demands, especially as health care shifts to outpatient settings. Historically, nursing as whole has faced barriers to gain full recognition for their contributions to patient care, particularly related to reimbursement for nursing care. This role, although complex and diverse, requires strong advocacy skills to ensure it can evolve and continue to address the growing needs of patients outside of hospital settings. The diverse and often siloed nature of ambulatory care nursing has made it challenging to find a cohesive voice to advocate for the profession and the diverse patient populations we serve.
The AAACN Advocacy Committee (previously the Legislative Committee) last surveyed AAACN members in 2019, prior to the pandemic. This information was used to help inform advocacy work and better meet AAACN member needs. It is imperative that we continue to raise the collective voice of ambulatory care nurses and stay the course in our advocacy efforts for ambulatory care nurses and our patients.
Methods: An online survey was conducted in Spring 2024 using a QR code, and emails were sent to the AAACN members' distribution list. The survey was comprised of nine items, including both multiple choice and free text question fields. Descriptive statistics were used to analyze quantitative data, while content analysis measured the frequency of policy priorities identified by members. The ambulatory care nursing conceptual framework was utilized to identify potential themes. Codes were assigned to like groups and content analysis was conducted using ATLAS.ti software.
Results: This survey was completed by 232 members, representing 5% of AAACN current membership. Most respondents worked in non-profit entities, with 58% non-direct patient care roles. Several questions were designed to assess knowledge and involvement in advocacy efforts. 34.9% of participants stated they were involved in organizational advocacy efforts. While approximately half of participants felt competent in their ability to impact organizational level policies, 63% reported that they were less knowledgeable about how to impact state and federal policies. Most participants felt knowledgeable about current legislative priorities. Free text responses captured participant legislative and regulatory priorities. A content analysis revealed five overarching themes: 1) professional practice and role of the ambulatory care nurse, 2) reimbursement, 3) staffing, 4) organizational workforce issues, and 5) workplace violence/safety.
Conclusion: It is imperative that organizations and policy makers recognize the value of the ambulatory care nurse voice in policy development and reform. Key priorities identified include articulating the key contributions of the ambulatory care nurse, ensuring full role optimization, addressing reimbursement for nursing services, standardizing staffing practices, and improving workplace safety. These insights helped to guide the AAACN Advocacy Committee in developing a unified platform with specific strategies to enhance member engagement. Proposed actions may include creating education resources, targeting social media messages, fostering strategic partnerships, and providing opportunities for direct policy advocacy at all levels.

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.

P094 - A Workflow to Improve Completed Telephone Triage with Patients Reporting Symptoms through Patient Portal Messages

Heather Bogrett, MSN, RN, AMB-BC | Ryan Gagnon, BSN, RN, CNML | Heather Ryan, PhD, RN, CPN

Updated: 04/22/25

Introduction: There has been rapid growth in the number of patients utilizing their patient portal to communicate with their healthcare providers since COVID. Despite guidance explicitly instructing people not to send messages related to urgent concerns, triage is still required of many client requests.
Background: Since November 2022, the primary care Epic MyChart messages of a midsized urban safety net health system (29% non-white; 63% primary language non-English) related to non-urgent medical questions and scheduling requests including report of symptoms have been routed to a centralized nurse triage department (NTD), averaging approximately 5500 messages monthly.
Problem addressed: Standard of care had been initiation of telephonic responses to messages warranting triage. A quality review of 200 calls over two weeks in June 2024 concluded that only 21% of initial calls resulted in message completion, and initial responses typically started at 48-business hours post-message receipt.
Methods: A project team including risk management and nursing and operations leadership was assembled. A literature search revealed no applicable studies have been conducted. A question posed on the AAACN telehealth community suggested other institutional workflows were consistent with ours.
Intervention: A standard message response was developed and approved in multiple languages, advising patients to call the NTD for further assistance. Nurses were instructed to scan messages for urgent or emergent concerns and respond with the standardized message if appropriate. Additionally, workflows were developed incorporating the primary care central scheduling team (CST). A “red flag” policy to guide non-clinical personnel on rapid identification of medical emergencies reported by offsite clients was updated to support CST screening of MyChart scheduling requests, including reported symptoms. The CST received 1:1 training on a new workflow entailing phone outreach and warm handoff to the NTD emergency line if a red flag symptom was reported or replying with the standard smart phrase in the patient’s preferred language.
Findings: Pilot of the updated workflows started in September 2024. Post-implementation quality review of 200 MyChart messages routed to the NTD on two dates in October 2024 showed 85% and 86% of patients following through with in reach after receiving the standardized message response. No “red flag” symptoms were reported among these messages. Time to initial message response decreased to 10 business hours on average. No relevant safety events have been reported.
Conclusion: Piloting a workflow for symptom-reporting patient portal messages that instructs patients on in reach to nurse triage has thus far resulted in a decrease in response times and an increase in nursing efficiency without compromising patient safety or quality of care in a diverse, safety net primary care patient population.

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.

P095 - “Falling” for Toolkits and Technology: Stepping Forward in Quality, Safety, and Prevention

Kimberly Burkeen, MSN, RN, NE-BC, Senior Nursing Projects Manager and Magnet Program Director, Vanderbilt University Medical Center

Updated: 08/10/25

Risk factor awareness, continuity of documentation, and action planning are key drivers in reducing patient harm related to falls. Designing and implementing nurse-led quality initiatives across a large ambulatory care footprint requires an innovative yet uncomplicated approach for front-line staff.
Falls pose a risk to patient safety in all medical settings and increase healthcare costs related to injuries. Rapid expansion of community outpatient services is addressing disparities and social determinants of health, yet rising acuity in this population increases the risk of falls in patients of any age and physical ability. An innovative approach is needed to identify at-risk patients and prevention strategies to decrease falls with outpatient procedures, surgeries, and pain management.
The falls prevention toolkit consists of an area assessment survey, a monthly audit survey, and a post-fall debrief huddle survey. In addition to the toolkit, staff utilize the Epic documentation tool for tracking all reported and witnessed falls. Falls prevention training is completed by all clinical staff via a learning management system module during orientation and is included in annual competencies. Patient education on falls prevention is provided to all at-risk patients in the after-visit summary. Falls are tracked via the incident reporting system, validated for severity of injury, and crosswalked with toolkit surveys to drive quality initiatives and prevent falls in each area.
Using an evidence-based, innovative approach has improved patient safety and the documentation of witnessed falls and patient-reported falls across the enterprise. Nurses are driving focused quality improvements, including in outpatient clinics and procedural areas across the state. The falls assessment is triggered for completion during clinic intake for all patients over 65. The use of these electronic tools has increased awareness of risk factors and improved visibility of patient-reported falls across multiple service lines for patients of all ages. Through these interventions, falls with injury decreased by 58% and total falls dropped by 42%.
A proactive, patient-centered approach helps identify at-risk patients and improves communication, leading to reduced patient harm. Utilizing innovative tools promotes nurse-driven quality improvement initiatives, and next steps include implementing this fall prevention strategy in inpatient units.

P096 - Onboarding Overhaul: A Journey to Improve One Organization’s Orientation Experience

Sharon J. Peacock, MSN, RN, AMB-BC

Updated: 08/10/25

Background: This ambulatory care services division continuously adjusts to the challenge of retaining clinical staff. In 2023, clinical staff first-year turnover rates were 23.4% for medical assistants, 15.2% for licensed practical nurses, and 12.5 % for registered nurses. Finding new ways to promote successful onboarding has always been a primary focus. According to the American Academy of Ambulatory Care Nursing (AAACN), orientation is a program that allows staff to adjust to their setting and to learn the standards established by the organization. The ambulatory care services division’s clinical new-hire orientation (CNHO) program covered various topics in 16 hours of virtual learning over three days during the first week of onboarding. Feedback received from surveys, direct observation, and verbally from orientees and leadership had been consistent, noting the considerable amount of information shared within a short time. Direct observation during follow-up visits with orientees noted that staff were unable to verbalize topics discussed and could not find resources reviewed, and the best practice workflows discussed during orientation were not implemented. This organization recognized an opportunity for change and initiated steps to improve the orientation experience.
Objectives: To improve orientee satisfaction and first-year retention rates by developing and implementing an expanded clinical new-hire orientation program.
Methods: The ambulatory care services division hired three additional nursing professional development generalists (NPDg). With the additional NPDgs, CNHO was expanded to 24 hours of virtual learning and a 4-hour in-person skills course. The program content was developed based on feedback from staff and leadership and direct observation of orientees. Orientation was offered over five days during the first three weeks of onboarding. In addition to updating the current programs and creating new training, the NPDgs moved from completing one-on-one 30-day follow-up visits with each orientee to conducting education support visits that promote clinical workflow best practices, review division metrics, provide real-time feedback, and answer clinical questions for the overall practice.
Results: Initial feedback has been positive. Staff have verbalized that in-person skills allowed for the practice of skills such as injections and the rooming process in a low-stress environment, fostering increased confidence once in the clinic. Managers and leaders alike have praised the new message management and pre-visit planning training, stating the training has positively impacted office flow efficiency and provider satisfaction. From April to October 2024, survey results noted that 97% of new hires either strongly agreed or agreed that the orientation program helped them prepare for their new role, compared to 95% during the same timeframe in 2023. Staff retention numbers will be available in early 2025.
Conclusion: Virtual orientation has proved effective for instructing clinical staff. The feedback from orientees and practice leaders has shown the added value of in-person education. Additionally, expanding in-person site visits to focus on the whole team has allowed for tailored educational opportunities.

P097 - Nurse-Led Diabetes Education Program

Kerri Pagliuca, BSN, RN-BC

Updated: 08/10/25

Purpose: To implement and evaluate a 3-session, nurse-led diabetes management program with peer support for nurses to help patients in primary care with uncontrolled type 2 diabetes (T2DM) better manage their condition.
Background/significance There is projected to be a significant physician and nursing shortage by 2030. Post-COVID, we have seen record numbers of physicians and nurses cutting back on their schedule or retiring. This has resulted in significant access issues in primary care. We wanted to look at a different model of care delivery that engaged nurses to work at the top of their license, helped share the work of the management of patients with chronic disease, and allowed them to perform more meaningful work.
Methods: A nurse-led diabetes education program with nurse peer support resources (monthly meetings with other nurses, with content experts) was implemented in five primary care clinics from November 2023 to September 2024; all 28 nurses from these practices agreed to participate. Patients were eligible if they were aged 18-70, had a PCP visit between 1/21-12/22, a diagnosis of T2DM, an A1c >8.5 and did not have a visit with the MGH diabetes center. The program included an initial phone call and three in-person or virtual visits conducted over 4 months. Each of these visits used a structured template to address individual patient knowledge gaps. Nurses were emailed a survey link at baseline, 4 months, and 10 months to evaluate self-reported confidence (primary outcome). By completing the survey, nurses consented to participate. Reminder emails were sent two weeks after the initial email and an incentive was provided for returning each survey. Nurses self-reported confidence, burnout, and satisfaction with the programs, and we measured use of the visit templates. Changes in A1c were also measured.
Results: Using the templates, nurses documented the following calls and notes: n=95 patient outreach calls, n=57 visit 1, n=33 visit 2, and n=17 visit 3, to date. Response rates for the nurse confidence survey were 95.8% (baseline), 95.8% (4 months), and 79.3% (8 months). The mean A1C for patients were 9.4 (baseline), 8.0 (4 months), and 7.4 (8 months). We are continuing to collect final results through 11/30. Additional analyses will include change in nurse-reported confidence across the three time points.
Conclusions/implications: We will continue to collect and analyze data after all patients have completed the third education visit. We will consider resources needed to expand this program to all primary care practices once data has been reviewed.

P098 - Emergency Department Clinical Nurse Leaders: Creating Valuable Care Coordination Solutions

Denise Wienand, MEd, MSN, RN, CNL, NEA-BC

Updated: 08/10/25

Objectives: Identify the role of the emergency department clinical nurse leader (CNL), focus of practice in a community hospital, and key care coordination strategies used.
Background: The CNL role quickly spread to all inpatient units at an organization since implementation in 2012 and is now fully operational in the emergency department. The CNL focuses on care coordination, organizational initiatives and education, and quality measures. The ED is a unique ambulatory care setting that is a gateway for the community to either access the hospital or connect with outpatient resources. Creating care coordination solutions for complex patients and vulnerable populations is at the heart of the ED CNL role.
Methods: The ED CNLs optimize interdisciplinary collaboration by functioning as a connector for care across many clinical settings. One key intervention that the ED CNL leads is that of the creation of complex care plans for the highest utilizer patients in collaboration with physicians, social workers, and other pertinent departments. Connections with primary care ambulatory care sites are achieved as well as community partnerships, tracking patient progress, and by making personal connections with patients.
Practices: ED CNLs aim to reduce hospital readmissions and ED utilization through a multifaceted transitions management program. Elements of the CNL role center on the RN as care coordinator, which is vital in today's healthcare environment.
Outcomes: The success of the CNL has been due in large part to positive change in 30-day hospital readmissions, length of stay, core measures, and other patient outcomes. The CNLs have developed complex care plans for the highest ED utilizers to help reduce 30-day all cause hospital readmissions. Additionally, the ED CNLs have begun to more intentionally create a pipeline for patients to primary care providers and available outpatient resources.
Recommendations: ED CNLs continue to broaden their scope of impact on chronic and vulnerable populations. CNLs to continue to engage with ambulatory care clinic nurses and other outpatient resources to sustain the important connections being made through complex care plans.

P099 - Identifying Barriers and Improving Antibiotic Stewardship in Urgent Care Settings

Tiffany Newell, DNPc

Updated: 08/10/25

The overuse of antibiotics has resulted in a concerning increase in antibiotic resistance, presenting a significant global public health challenge. Urgent care clinics have the highest antibiotic prescribing rates compared to other healthcare settings, underscoring the need for evidence-based interventions to tackle this problem. Antibiotic stewardship programs (ASPs) are specifically designed to optimize antibiotic usage, improve patient outcomes, and combat antibiotic resistance. The proposed project aimed to assess the knowledge, attitudes, and perceptions of healthcare providers in urgent care regarding antibiotic stewardship. Additionally, the project aimed to implement the MITIGATE antibiotic stewardship toolkit to reduce antibiotic overuse in rural urgent care facilities.
The primary objective was to achieve a 10% decrease in the overuse of antibiotic prescribing for acute respiratory infections among urgent care providers within eight weeks of project implementation and evaluate the impact of the antibiotic stewardship program on advanced care providers' attitudes, knowledge, and perceptions of antibiotic stewardship. The evaluation method included pre- and post-implementation surveys administered to advanced care providers, as well as the collection and analysis of antibiotic prescription rates for acute upper respiratory infections.
While the project was specific to a particular region and may not be entirely generalizable, the successful implementation of evidence-based antibiotic stewardship strategies helped alleviate antibiotic overuse in urgent care settings and contributed to the fight against antibiotic resistance. Based on these findings, it is recommended to consider integrating antibiotic stewardship programs in urgent care settings on a broader scale to improve antibiotic prescribing practices, reduce antibiotic resistance, and enhance patient outcomes.

P100 - Empower & Engage: Nurses Shifting Workplace Culture via Shared Governance

Jennifer Lindstrom, MSN

Updated: 08/10/25

With the recent addition of first contact resolution centers (FCRC), telehealth is now widely accepted as a standard healthcare practice, due to its convenience and high patient satisfaction levels (Poots). FCRC continues to adopt enhanced virtual healthcare solutions to increase access to healthcare by modernizing systems and expanding the range of care offerings. To align with this modernization, a virtual nursing shared governance (NSG) is essential to empower and propel the front-line nursing staff.
Nurses are the front-line deliverers of care within the FCRC, but data within this FCRC suggests that the nurses perceive their voice is lacking with the decision-making process. Traditional governance models may not fully address the uniqueness of the virtual care environment, such as coordinating care, integrating technology, and ensuring consistent communication with the entire healthcare team. By implementing NSG, nurses can take an active role in reshaping policies and procedures, improving care standards, and advancing practice innovation.
The decisional involvement scale (DIS) was employed to survey the 67 nurses. The anonymous DIS is a 21-item survey to investigate shared governance readiness. The response rate was 75% (50/67). There was minimal cost associated with marketing; efforts focused on dissemination via email and virtual common boards.
The results conveyed a clear momentum for practice transformation towards the creation of virtual nursing shared governance. The findings concluded that front-line nurses desire to participate in the daily decision-making processes; the current state lacks the involvement that nurses are eager to experience. This data propels a data-driven path forward with nurses expanding their influence on the quality of care they provide.
The proposed NSG framework is structured around healthy work environment principles of nursing empowerment, accountability, and collaboration. NSG will foster leadership skills among front-line staff nurses by promoting participation in the decision-making process, encouraging professional development, and fostering mentorship. A primary goal is to create an inclusive and welcoming nursing NSG environment. Although our initial conception focused solely on nursing, future expansion will include interdisciplinary collaboration. This is vital to integrate telehealth platforms for seamless workflows, to provide optimal patient care and outcomes.
Anticipated outcomes are expected to improve patient results by ensuring that nurses have a direct role in shaping the virtual unit. Improved engagement and satisfaction among front-line staff nurses work to empower each as they contribute to the daily decision-making processes. This will also improve care coordination and strengthen collaboration with leadership, as well as offer more opportunities for growth. Essentially, these outcomes will contribute to a higher quality of care for veterans receiving virtual triage services as well as offer a more flexible, responsive, and emergent healthcare experience.
In conclusion, the creation of a nursing shared governance represents a significant step toward empowering nurses, improving care quality, and enhancing the overall virtual care experience for both patients and nursing staff.

P101 - Analysis of a Medication Reconciliation Learning Needs Assessment across Ambulatory Care Roles

Dana Radle, MSN, RN, AMB-BC

Updated: 08/10/25

Faced with a national shortage of licensed nurses and trained medical assistants, many ambulatory care clinics are experiencing a transformation of the traditional care team to include unlicensed care assistants (UCA). UCA function varies across practices, but emphasis on ambulatory care rooming workflows is a key priority within our regional health system in the Midwest. UCAs participate in medication review/reconciliation processes following the completion of a basic pharmacology course, electronic health record training, and precepted orientation. Feedback from UCAs indicates that medication review knowledge and workflows are among the most challenging aspects of the role. Meanwhile, the Joint Commission emphasizes the importance of maintaining and communicating accurate home medication lists as a patient safety strategy.
Nursing professional development (NPD) practitioners sought to better understand medication reconciliation knowledge and practices across ambulatory care roles using a learning needs assessment (LNA). LNA is a standard method used by NPD practitioners to describe the nature of a nursing care gap as it relates to knowledge, skill, or practice.
A 27-question LNA was administered to 187 ambulatory care nursing team members across multiple clinics. The questionnaire captured demographic data to include role, care area, and length of service in role. Assessment questions were designed to evaluate understanding of common medications/indications, routes, abbreviations, and confidence level with the medication reconciliation process. Survey participants were prompted to share information about their frequency of medication resource utilization. Scenario-based questions further helped to gauge whether policy/procedural expectations were being applied to practice.
The LNA revealed that all roles scored with high accuracy on questions about common medication identification/indication. Using a 1-5 Likert scale, confidence with medication reconciliation variably measured with means from 3.44 – 4.51 across all roles. Unlicensed staff and those working within any role < 2 years rated themselves lowest, while LPNs rated highest. Confidence levels across all roles were lower with means of 3.77 for those in a role < 2 years compared to means of 4.33 for those having worked 2+ years in that role. Result analysis indicated UCAs use Google™ as a medication resource more frequently than evidence-based resources, while licensed/trained roles use evidence-based resources more often. The most significant gaps were identified across all roles on institutional medication reconciliation policy/procedural workflows.
LNA is an essential tool that informs on current-state practice. The discovery of inconsistencies around resource utilization and lack of knowledge about medication reconciliation policy/procedural workflows allowed for the creation of targeted education. In conclusion, basic pharmacology preparation was found to benefit the unlicensed role and confidence increased through continued exposure to medication review workflows over time.

P102 - Transitioning from Panel Management to Population Health: Nurses Leading Comprehensive Health Promotion and Disease Prevention

Jacqueline Brumbaugh, MSN, RN, CEN, AMB-BC

Updated: 08/10/25

Objectives:
1)    Improve patient outcomes through population health management
2)    Improve nursing satisfaction and retention
3)    Improve management of ambulatory care sensitive conditions
Purpose: Ambulatory care registered nurse care managers have historically focused on reactive care rather than proactively identifying and implementing preventative health promotion and disease prevention. Research shows that this has resulted in fragmentation of health care, nurses working in silos, increased healthcare costs, ineffective communication, decreased job satisfaction, and inferior patient outcomes. Ineffective communication is a leading contributor to patient injury. To correct this, one healthcare system is shifting from panel management to population health management. Our leadership team posited that the development and integration of an RN training program focused on data mining and population health in care management would be not only beneficial but necessary to improve quality of care, patient outcomes, and staff satisfaction.
Description: Utilizing a plan-do-study-act model, the leadership team collaborated with all interprofessional leaders to define and clarify roles and responsibilities to enable all team members to work to the full scope of their licensure and education. They reviewed baseline patient outcomes including HEDIS measures, ambulatory care sensitive conditions, and admissions/discharges. They then developed training to introduce population health management and the utilization of data dashboards, post-hospitalization transition and follow-up, and ambulatory care sensitive condition reports to identify comorbidities and gaps in care as well as those who would benefit from preventative care management. The same metrics were then monitored monthly including retroactive reviews of staff care management documentation. Weekly staff meetings were held to review case studies and identify any barriers or opportunities for process improvement. Leadership mentored healthcare teams through team huddles and communication opportunities. Population healthcare management has now been successfully implemented in this clinic for over a year. Best practices have been developed and are now being spread to other VA clinics.
Evaluation and outcome: While initial clinic outcomes surpassed national outcomes in most benchmarks, the team further improved both quantitative and qualitative outcomes. This shift in practice improved registered nursing satisfaction, as shown on the annual all employee survey. Quantitative outcomes have included improved hypertension and diabetic control, increased vaccination, and improved women’s health. It has provided an opportunity for remote work for nurses while increasing both in-person and virtual patient nursing visits. This has increased healthcare accessibility, especially for those veterans who live in remote areas, while transitioning directly into future nursing bookable expectations. Qualitative outcomes have shown increased patient satisfaction with comments from patients stating that they are now healthier and are effectively managing their comorbidities.