Development of Ambulatory Care Nurse Role Clarity Tool

Our colleagues noted a knowledge deficit related to role clarity and scope of practice in the ambulatory care setting. The purpose of this work is to provide a comprehensive resource that will improve ambulatory care leadership and staff’s knowledge related to the different types of clinical team members and address how each level of licensure and education shapes opportunities and limitations. The guiding principles by which this work evolves are all roles are appreciated and valued in the practices, and all individuals are working to the top of their education and licensure to maximize value for the practice and patients while increasing employee satisfaction.

A workgroup of ambulatory care nursing professionals facilitated the project conferring with internal and external content experts. The team facilitated focus groups to assimilate appropriate content and tools in the development of the toolkit, communication, and education plan. The toolkit is comprised of three reference documents accessible to the end user through the organizational intranet: 1) scope visual summary and guide – a 30,000 ft illustration of the range of roles, functions, responsibilities, and activities members of the patient care team are educated and authorized to perform; 2) scope of practice comparison chart – by law, the scope of practice and allowable duties differ for the nurse practitioner (NP), registered nurse (RN), licensed practical nurse (LPN), medical assistant (MA), and this chart provides a snapshot comparison; 3) table of value and task matrix – a guide by team member and task to demonstrate the value of each clinical team members’ role in the practice.

Implementation of the toolkit accompanied a robust communication and education plan framing the intended use and expected outcome as teams utilize the resources to make informed decisions related practice operations. Nursing leaders reinforce the application of the toolkit for decision-making and education using modeling and coaching strategies. The focus groups and consultation with experts in the organization provided valuable insight that delivered an optimal toolkit to meet the needs of our administrative and clinical colleagues. Refinements were made based on end user feedback and ease of use to meet the goals of the project. Education was delivered by nursing leaders to 500 staff members, 75% nursing, 50% administrative staff, and 25% MD to the use of the tool.

Results are in progress, and the team delivered an evidence-based resource for ambulatory care leaders and staff to assist with role clarity in the context of hiring decisions and discussions based on practice needs related to RN vs. LPN vs. MA scope of practice. The hypothesis is that with the implementation of this toolkit turnover rates for nurses and MAs will decrease by 15%.