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P083 - Financial Fluency: The Currency of Today’s Nurse Leader
Tiffany Street, DNP, ACNP-BC

Updated: 05/18/25

Updated: 05/18/25
Financial management skills are a core competence for nurse leaders and are more relevant today than ever. The American Organization of Nurse Leaders (AONL) and the American Nurses Association have included financial understanding in their core competency models. Within these competencies, the nurse leader must not only have knowledge of financial management but also execute budgets and human resource management and articulate the fiscal impact of decisions.
In the ambulatory care setting, nurse managers are responsible for the clinics' financial performance, including labor expense management and advocacy for resources to meet patient care demands. However, many nurse managers do not feel equipped to speak the language of finance. Therefore, it is essential to develop educational programs and opportunities to strengthen their financial management competencies.
Background: Our facility is a heart and vascular institute within an extensive academic health system in the southeast region of the United States, responsible for 220,000 visits per year across 22 ambulatory care clinics. The institute employs 15 hiring managers who manage over 450 FTEs. With the large number of positions and the financial impact of the salary expense, internal control over resource planning and productivity management was essential. There was an identified gap in the required skills of a manager to build a business case for human capital needs adequately.
Intervention: The heart and vascular institute executive leaders provided training for nurse managers to close the gap in financial skill management. The key focus areas were managing position control, forecasting staffing requirements, identifying and reviewing key performance cost drivers, and developing a business case for change. These focus areas align with the AONL competencies of a nurse leader.
The hiring manager learned to identify the need for additional human resources, justifying this while balancing the clinic's volume and productivity and developing a data-driven justification for the position based on organizational productivity analytics. Additionally, the manager learned how to determine and manage key cost drivers, such as paid overtime and premium salaries. The manager was required to present a business case to a central committee of executive leadership and hiring managers. The committee met weekly to address human resource needs and scrutinize the business case for the resources. The committee reviewed 112 positions in FY24.
Outcomes: Upon implementing the process, the hiring managers have exhibited more confidence in making a compelling business case and have improved their financial acumen. The managers managed the budget to actual FTE variances while managing clinical productivity and decreased the use of overtime and premium salary dollars to below budget. The focus of financial training of nurse leaders leads to professional accountability and management of the financial health of the clinics they lead.

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.

P084 - Enhancing Nurse Engagement and Leadership through an Ambulatory Care Nursing Clinical Ladder Program
Lindsey Gatton, MSN, RN, NPD-BC    |     Kiana Scott, MSN, RN, NPDS, CNML, CCRN-K

Updated: 04/22/25

Updated: 04/22/25
The project’s purpose was to create an effective ambulatory care nursing clinical ladder program to promote nurse engagement, leadership, professional growth, and retention. A nurse’s work engagement is positively associated with job satisfaction and their perceived quality of care and negatively associated with their intent to leave a position. Within this academic institution, an inpatient clinical ladder program was well established; however, ambulatory care nursing lacked a clinical ladder program.
Nurses participating in shared leadership recognized the need for a clinical ladder program highlighting the unique specialty of ambulatory care nursing. Essential stakeholders including nursing practice, education, leadership, and human resources developed the program. The group utilized six essential steps for development: inpatient program framework alignment, measurable program criteria, recognition system establishment, peer support network creation, and the addressing of program sustainability.
The inpatient clinical ladder program framework was reviewed to assess for alignment opportunities and applicability within the ambulatory care setting. Benner’s (1982) novice to expert theory and the AAACN Scope and Standards were utilized to establish a rubric with measurable criteria for each ladder step (advanced and expert). The criteria included certification, specialty expertise, leadership, research involvement, community engagement, and a clinical exemplar.
The group partnered with human resources to create incentives and recognition plans within shared leadership forums. Program sustainability was also addressed with continuous program evaluation including bimonthly steering committee meetings. The committee comprised of ambulatory care leaders and nursing professional development specialists routinely reviews the need for updates to the program and modifications to its criteria. Lastly, a peer support network was established through the creation of a clinical ladder champion role.
Outcomes: The clinical ladder program showcases substantial engagement among nurses, with 52 promotions (32 advanced and 21 expert) across 28 departments. Activity involvement included quality improvement initiatives (n=41,80%), task force/committee work (n= 33, 64%), educational materials development and led in-services (n= 32, 62%), shared leadership involvement (n= 22, 43%), policies and procedures development (n= XX, 41%), and community engagement (n=14, 27%). Nurses involved in the clinical ladder have a retention rate of 96%. Additionally, 12 nurses were clinical ladder champions assisting prospective applicants.
Implications for practice: The utilization of a clinical ladder for ambulatory care nurses enhances retention, job satisfaction, and engagement locally, regionally, and internationally. By developing a structured pathway for professional advancement, nurses feel encouraged to pursue continuous learning, skill development, and foster a sense of value within the organization.

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.

P085 - Development and Evaluation of a Model for an Undergraduate, Precepted, Ambulatory/Community Care-Based Clinical Experience
Rebecca Mitchell, DNP, MSN, APRN

Updated: 05/18/25

Updated: 05/18/25
Learning outcome: Describe features of an academic clinical coordinator (ACC) model and identify ACC model implementation evaluation strategies.
The value of registered nurses in the ambulatory care setting is now recognized as vital to the overall health of local communities. Unfortunately, organizing meaningful ambulatory care clinical experiences for BSN students remains a challenge. Academic practice-partnership models to guide ambulatory care experiences and help students build competency in this complex area are currently lacking. The academic clinical coordinator (ACC) model permanently assigns a school of nursing faculty member to an organization to coordinate ambulatory care clinical experiences for BSN students. Per the model, ACC responsibilities include preceptor training, site maintenance, quality improvement projects, and assurance of the relationship being beneficial to both university and healthcare organization. The purpose of this project was to test and refine the model in a large community health system.
The ACC model was implemented over a two-year period in a precepted BSN senior-level course and tested at ambulatory care clinics in a large community health institution. The goal was to enhance BSN students’ population health and systems-based practice competency development, strengthen the relationship between the school of nursing and the community health system, and enhance preceptor development/retention.
Program evaluation was conducted using both qualitative and quantitative methodologies focused on student, preceptor, clinical faculty, and leadership perspectives to iteratively improve the ACC model. Quantitative data were obtained using validated tool and focus groups were conducted with student clinical groups, preceptors, and clinical faculty and nurse managers. Feedback from the community hospital system’s nurse educator and administrator were also obtained.
Student outcomes support the continued implementation of the ACC model. Students in the ACC group demonstrated enhanced competency in population-based health and systems-based practice through competency assessment and quality improvement project assessment compared to their peers in the traditional course. Students appreciated the role that preceptors and managers played in integrating them into the facility, including providing mentorship and guidance in conducting meaningful quality projects. Preceptors and clinical faulty both reported overall satisfaction with the model but identified some challenges in initial implementation, such as coordinating site visits and relationship maintenance while teaching. Nurse managers appreciated the increased communication and involvement of the students in unit-based quality improvement projects. Organizational leaders believed the ACC model enhanced outcomes compared to prior semesters in which students were placed in ambulatory care settings. Importantly, the mutual relationship built between the university and healthcare organization was strengthened as a result of the ACC model, leading to improved outcomes for students including continued access to upcoming clinical placements.
Future work will focus on implementing a refined model that clarifies roles and relationship maintenance elements of the ACC model between the university and healthcare system, specifically, the role of the clinical instructors. Initially it was expected that all clinical instructors could take on the ACC role; however, after the initial implementation of the model, it was clear that a single ACC was more effective at building strong relationships between the academic and clinical 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.

P086 - Using RN Referral Triage to Increase Efficiency of Cardiology Referrals
Ashley McAlpin, MSN, RN

Updated: 04/22/25

Updated: 04/22/25
Description: Appropriately timed access to medical specialist care for evaluation and non-emergent procedures is critical in achieving better health outcomes and reduced health care costs for patients. Delays in care access for patients with chronic illnesses may be managed, in part, by interventions focused on increasing the efficiency and effectiveness of referral to specialty care. Our heart and lung clinic accepts referrals of adults with cardiac disease from across four states. Our clinic includes general cardiology and nine cardiology sub-specialties.
Purpose: To evaluate the intervention of registered nurse-led triage to increase the effectiveness and efficiency of referrals to the cardiovascular institute.
Methods: We used the plan-do-study-act (PDSA) cycle to plan and evaluate this IRB-approved project. The intervention used registered nurses to provide triage of patients referred for cardiology appointments instead of the previous appointment system of first-come, first-served. The pre-intervention time period was September 2022 to February 2023; T1). The post-intervention time periods were March 2023 to August 2023 (T2) and September 2023 to February 2024 (T3). Data from the 6-month pre-intervention period was compared to the subsequent two 6-month post-intervention periods (18 months total) for the total number of referrals per month and length of wait time associated with adult cardiology referrals with GOAL for the length of time from referral to clinic appointment of 7 days. All data were accessed via de-identified EPIC electronic medical record (EHR) reports.
Outcomes: Total volume: An average of 557/month were made in the T1 period. Post-intervention, an average of 683 referrals/month were made in T2 and 698/month were made in T3. A mean of 297 patients/month were seen in pre-intervention period. A mean of 484 patients/month were seen in the first 6 months post-intervention, an average of 491 patients/month were seen in the second 6-month period, and an average of 591 patients/month were seen in the third 6-month period post-intervention. Length of wait time: During the 6-month pre-intervention period, about 7% of newly referred patients were seen within 7 days of their referral. During the third 6-month post-intervention period, a mean of 17.7% of patients were seen within 7 days of their referral.
Evaluation: By 18-months post-intervention, we see 2.5 times as many patients with nurse triage compared to the pre-intervention period. Registered nurse triage has increased the effectiveness and efficiency of referrals to the cardiovascular institute. However, even with nurse triage, we are limited by inadequate numbers of specialized cardiac physicians compared with patient need.

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.

P087 - A Quality Improvement Initiative to Improve Nursing Clinical Documentation Quality in Hospital-Based Ambulatory Care Centers
Alicia Keeney, MSN, RN

Updated: 04/22/25

Updated: 04/22/25
Improving nursing clinical documentation quality in hospital-based ambulatory care centers presents a unique and multifaceted challenge for ambulatory care educators and leaders. Bunting & de Klerk (2022) describe clinical documentation as “the process of creating a written or electronic record that describes a patient’s history and the care given” (p. 1). At our hospital-based ambulatory care centers, clinical documentation education begins during orientation and is emphasized throughout the year. In addition to both live in-services and online modules, chart auditing is also completed by the ambulatory care nursing educator to assess and reinforce nursing clinical documentation quality. Chart auditing can be described as “a quality management tool…a systematic process to review patient care against defined and agreed criteria in order to identify practice gaps” (Ramukumba & El Amouri, 2019).
At our hospital-based care centers, three charts per nurse are audited every two weeks during orientation. Once nurses have successfully completed orientation, one chart per nurse per month is audited. Prior to 2024, feedback on audit results was not shared routinely with staff nurses. In 2023, our overall chart intake audit average dropped nearly two percentage points from the previous year. In February 2024, a new quality improvement initiative was begun with the aim of improving nursing clinical documentation quality. The first part of this initiative comprised of emailing each nurse in the department their complete chart audit for the month, along with their productivity numbers, which include the number of patients on whom an intake was completed, number of patients discharged, number of allergies reconciled, and number of vaccines given for that given month. The second part of the initiative titled “chart audit champions” was started. This initiative involved sending an email to all members of our department to highlight each nurse who received a 100% on their chart audit for that month.
Since beginning these initiatives, we have seen significant improvements in our nursing clinical documentation quality. The first month (February 2024) “chart audit champions” began there were 12 nurses who earned the designation. In September 2024, there were 36 nurses, a 33.3% increase. As a result of these initiatives, our overall chart intake average improved from 91.5% in 2023 to 94.7% YTD in 2024.

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.

P088 - Implementing a Symptom Management Log to Improve Post-Operative Cystectomy Outcomes
Felecia Museau, BSN, RN    |     Yasmin Sterling, MSN, RN    |     Jennifer Tighe, BSN, RN

Updated: 04/22/25

Updated: 04/22/25
Purpose: Radical cystectomy is an invasive, life-altering procedure that presents significant challenges in a patient recovery. Length of stay for these procedures has decreased with enhanced recovery after surgery programs resulting in a greater proportion of recovery at home. The primary goals of this project are to empower patients with greater autonomy, enhance their perception of preparedness for self-care following their surgical procedures, and reduce 30-day readmission rates.
Description: We developed a daily symptom management log for patients to track their temperature, incision appearance, pain level, fluid intake, urine output, ambulation, and bowel movements.
At the patient’s preoperative visit, the clinic RN provides standard procedure education along with a focus on early recognition of potential complications and use of the symptom management log when discharged home.
To ensure comfort with completing the log, the patient/caregiver practices use during their hospital stay and the inpatient RN reviews. On the day of discharge, a picture of the incision is taken and uploaded into the patient electronic medical record. Standard discharge instructions and copies of the log are sent home with patient. Appointments are scheduled for an NVO (nurse visit only) virtual appointment with a GU clinic nurse 2-3 days post-discharge to review the symptom log and patient education needs and answer questions of the patient/caregiver. The patient’s incision is viewed by the nurse via the video call or photo uploaded by the patient. The patient is encouraged to continue utilizing the log until their clinic visit which is scheduled within 14 days of discharge. Patient completes a 4-question survey (Likert scale and free answer) at their post-op visit regarding preparedness to care for themselves at home after surgery.
Evaluation: Patients are empowered to be more involved and diligent with monitoring and reporting of symptoms and concerns in the post-op setting from home. The interventions show improvement in care at home and increased patient awareness to care for self after cystectomy. A decrease is seen in incidence of 30-day readmission and readmission length-of-stay.

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.

P089 - Transitional Care Management: There and Back Again... A Patient’s Journey
Amanda Spicer, MSN, RN, NPD-BC

Updated: 04/22/25

Updated: 04/22/25
Life after a hospital stay can have a few trials and tribulations, just like a great work of fiction. However, the patient's story is still unfolding. With care coordination support from nurse care navigators, the patient can overcome these challenges and safely complete their journey back home. Nurse care navigators assist the most vulnerable patients as they transition from an acute care hospital to the community setting in which they previously resided. Without their support, many patients may not receive a post-hospital stay follow-up within two weeks of discharge. The purpose of this presentation is to demonstrate how good patient identification tools, efficient documentation workflows, and coordination with other teams can help other organizations grow their transitional care management (TCM) program.
The health system has 12 community hospitals. The physicians group has roughly 75 primary care practices located in multiple counties in Northeast Indiana. In 2022, transitional care management coded visits (CPT codes 99495 & 99496) totaled only 3,201. There was an opportunity to support patients as they transition from the hospital and increase utilization of these TCM CPT codes. Lack of awareness about the TCM program and its requirements was present among both providers and care team members. Standardization of the interactive outreach documentation, as well as the creation of a uniform provider encounter note, was needed.
A report was created within EPIC to list all patients discharged the day prior from one of the 12 acute care hospitals. Obstetric patients and those discharged to a skilled nursing facility or hospice were excluded from the report. A telephone encounter dot phrase was developed that included a standard list of assessment questions the nurses would ask the patients. We also collaborated with an EPIC physician builder to create a transitional care management encounter for the providers to utilize. We educated and trained both providers and care team members on the two new standard notes.
Through this work, we identified the importance of communicating and getting feedback from all stakeholders involved in the TCM process. This includes hospitalist/rounding nurses, schedulers, care team members, providers, TCM nurses, and patients. As patients have started utilizing more electronic messaging verses phone communication, we have stayed nimble by implementing an EPIC MyChart TCM questionnaire. The provider’s note was also built in such a way that it can automatically pull the required documentation elements (e.g., location of hospitalization, date of discharge, interactive contact date, community setting to which they are returning) from the nurse’s encounter, making it much easier for the providers. Year to date for 2024, the total number of post-hospital stay encounters coded for TCM exceeds 6,300! Not only have we increased the revenue for the organization, but we have also been able to advocate and support patients with medication and social needs who otherwise would have gone back to the ER, helping to reduce readmissions and overall cost of care.

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.

P090 - Women’s Sexuality after Gynecologic Cancer Treatment: A Phenomenological Inquiry
Jessie Desir, PhD, RN, AMB-BC-OCN

Updated: 04/22/25

Updated: 04/22/25
Purpose: The purpose of this qualitative hermeneutic phenomenological study was to explore the lived experiences of women's sexuality after gynecologic cancer treatments. The study aimed to give these women a voice to express their unique experiences with this significant aspect of their lives.
Significance: Cancer remains a leading cause of death worldwide. Gynecologic cancers are the most prevalent among women, contributing notably to global and national mortality rates. With the expected rise in gynecologic cancer diagnoses, particularly for younger women, the effects of treatments on women's sexuality are increasingly important. Women's sexuality after gynecologic cancer treatment is a phenomenon significant to nursing practice because it aligns with Maslow's hierarchy of needs, which forms the basis of human survival. Sex is categorized within the physiological needs tier of Maslow's hierarchy alongside essential functions such as breathing and eating. An unmet need within the aspect of sexuality may hinder the optimal functioning of the human body. Addressing the impact on women’s sexuality is essential and often overlooked in survivorship care.
Methods: This study was guided by an interpretivist paradigm, emphasizing a profound interpretation of women's experiences with sexuality post-treatment. The research utilized a qualitative hermeneutic phenomenological approach, incorporating purposive and snowball sampling methods. Data collection involved semi-structured, auto-recorded interviews, which were transcribed and verified for accuracy. This comprehensive process allowed for a thorough and meaningful interpretation of the phenomenon.
Findings and interpretations: Data analysis revealed five key themes that encapsulated the lived experience of women's sexuality after gynecologic cancer treatment: 1) hopelessness, 2) pain after treatment, 3) losing former sense of sexuality, 4) lacking conversation about women's sexuality, and 5) survivorship. These themes emphasize the need for holistic nursing care.
Discussion: Grounded in Max van Manen's hermeneutic phenomenology, this study unveiled the complexities women face as they navigate unfamiliar experiences with their sexuality after treatment. Participants' narratives highlighted numerous challenges affecting their physical, psychological, and social well-being. These insights contribute to a deeper understanding of women's experiences after gynecologic cancer, offering valuable knowledge to inform further research and guide the development of psychosocial support within survivorship care plans. By addressing sexuality as a fundamental need, nurses can adopt a holistic approach that fosters optimal patient outcomes and supports women in their cancer survivorship journey.

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.

P091 - Implementing the Kidney Allocation System to Optimize the Kidney Transplant Waitlist
Nico Buan-Lagazo, DNP, CNS, RN, AGCNS-BC, NEA-BC

Updated: 04/22/25

Updated: 04/22/25
Ambulatory care (AC) clinical specialization and diverse practice sites often lead to registered nurses (RNs) working in “silos.” It is difficult for AC RNs to maintain a sense of camaraderie, professional community, and collaboration across disciplines, resulting in threats to nurse retention and potential burnout.
Purpose/goal: The overarching goal of this project was to examine whether implementing ambulatory care nursing grand rounds (ACNGR) promotes knowledge development, collaboration, and professional community among registered nurses.
Background: The ambulatory care nurse practice council (ANPC) performed a gap analysis focusing on the needs of AC RNs as part of the interdisciplinary team. A literature review was done focusing on ACNGR as a tool of episodic education and its positive effect on AC RN job satisfaction, morale, and team involvement. Additionally, a literature review was conducted that focused on the healthy work environment framework “true collaboration” standard.
Methods: Before NGR implementation, AC RNs were surveyed on their NGR topics of interest, and then a series of AC focused NGRs were conducted based on top choices from staff: emerging pathogens, disaster/emergency preparedness, and social determinants of health with aspects of burnout/resiliency interwoven. Two AC NGRs were held in May and July 2024 via a hybrid approach (in-person and virtual option). The third NGR is scheduled for November 2024. Pertinent annual employee engagement survey questions were reviewed pre- and post-ACNGR. In addition, post ACNGR surveys were collected and analyzed to measure success. We learned after the first ACNGR that more data was needed and added to our post-survey to obtain more useful information.
Results: By providing a forum to share clinical expertise and best practices via NGRs, RN attendees were engaged in learning and understanding topics pertinent to ambulatory care and expressed they can more effectively collaborate throughout and between teams. AC RNs felt the NGRs were beneficial and promoted reflection on practice, and most attendees stated that they learned something new. Due to challenges in meeting times, attendance, and accessibility related to the variability of clinic sites and staffing, the sessions were also posted internally online. While it remains a work in progress, after the third NGR, the overall results will be compiled and reported. Overall, there were several lessons learned. One lesson learned is that it would be beneficial to a permanent implementation of a sustained nursing grand rounds 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.

P092 - Silos No More: Ambulatory Care Nursing Grand Rounds Adding Value for True Clinic Collaboration
Maureen Berry, BSN, RN    |     Audrey Kaplan, BSN, RN    |     Jacqueline O'Leary, BSN, RN-BC

Updated: 04/25/25

Updated: 04/22/25
Ambulatory care (AC) clinical specialization and diverse practice sites often lead to registered nurses (RNs) working in “silos.” It is difficult for AC RNs to maintain a sense of camaraderie, professional community, and collaboration across disciplines, resulting in threats to nurse retention and potential burnout.
Purpose/goal: The overarching goal of this project was to examine whether implementing ambulatory care nursing grand rounds (ACNGR) promotes knowledge development, collaboration, and professional community among registered nurses.
Background: The ambulatory care nurse practice council (ANPC) performed a gap analysis focusing on the needs of AC RNs as part of the interdisciplinary team. A literature review was done focusing on ACNGR as a tool of episodic education and its positive effect on AC RN job satisfaction, morale, and team involvement. Additionally, a literature review was conducted that focused on the healthy work environment framework “true collaboration” standard.
Methods: Before NGR implementation, AC RNs were surveyed on their NGR topics of interest, and then a series of AC focused NGRs were conducted based on top choices from staff: emerging pathogens, disaster/emergency preparedness, and social determinants of health with aspects of burnout/resiliency interwoven. Two AC NGRs were held in May and July 2024 via a hybrid approach (in-person and virtual option). The third NGR is scheduled for November 2024. Pertinent annual employee engagement survey questions were reviewed pre- and post-ACNGR. In addition, post ACNGR surveys were collected and analyzed to measure success. We learned after the first ACNGR that more data was needed and added to our post-survey to obtain more useful information.
Results: By providing a forum to share clinical expertise and best practices via NGRs, RN attendees were engaged in learning and understanding topics pertinent to ambulatory care and expressed they can more effectively collaborate throughout and between teams. AC RNs felt the NGRs were beneficial and promoted reflection on practice, and most attendees stated that they learned something new. Due to challenges in meeting times, attendance, and accessibility related to the variability of clinic sites and staffing, the sessions were also posted internally online. While it remains a work in progress, after the third NGR, the overall results will be compiled and reported. Overall, there were several lessons learned. One lesson learned is that it would be beneficial to a permanent implementation of a sustained nursing grand rounds 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.

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