A Statewide Initiative to Strengthen the Nursing Workforce Entering Ambulatory Care Practice: Impacting Retention and Skill Acquisition

Learning outcome: The learner will identify steps taken in the process of developing a statewide transition to practice ambulatory care nurse apprenticeship program.

Purpose: The purpose was to create a statewide ambulatory care nursing apprenticeship program in under-resourced organizations. Experts in ambulatory care nursing and teaching/learning methods implemented the program, which traversed a large geographic region. Particular foci of the program included ambulatory care specific topics, well-being support for ambulatory care nurse apprentices, and development of skill acquisition. One priority for this program was to allow multiple employers who needed expertise in ambulatory care and apprenticeship programs to participate and support new nurses to the ambulatory care specialty.

Description: Utilizing a synchronous Hyflex virtual learning environment, the program partnered with organizations seeking support for nurses new to ambulatory care. Partnering with regional workforce development boards and hospital trade associations located in underserved communities in Southern California, the first registered nurse ambulatory specialty apprenticeship program was implemented. One of the key goals of the program was to address retention and professional growth of the apprentice nurses transitioning into ambulatory care professional practice. The 12-month program included 240 hours of instruction and 1700+ hours of on-the-job training. The curriculum framework was created utilizing the American Academy of Ambulatory Care Nursing (AAACN) competencies and standards. The program provided a psychologically safe environment that supported the nurse apprentices with the myriad of morally stressful situations encountered in the ambulatory care environment.

Evaluation/outcomes: From the initial to the final self-evaluation, every apprentice met all competency standards as established by the AAACN Scope and Standards for program completion. The significant morally distressing situations encountered by the apprentices were mitigated utilizing a reflective journaling pedagogy and psychologically safe discussions. The nurse retention rate in the program was 89%, which included two nurses who were promoted while in the program within their hiring organization. The benefits to under-resourced organizations were being able to provide a no-cost apprenticeship program, investment in the organization through the apprentices’ quality and process improvement projects, and a high retention rate at the end of the program. Program outcomes included ongoing financial support for the apprenticeship program to expand to other regions of the state with the ability to accept the next cohort of nurses from returning partners as well as new ambulatory care organizations. In addition, providing a statewide apprenticeship program in ambulatory care nursing supports the health and well-being of the state’s population.