Enhancing Nurse Engagement by Redesigning the Ambulatory Care Nurse Practice Committee

Purpose: The purpose of the revised general internal medicine (GIM) nurse practice committee (NPC) was to improve nursing practice, patient experience, and nurse satisfaction under clinical nurse specialist (CNS) leadership and in collaboration with nurse managers (NMs) and GIM nurses. Dery et al. (2022) explored the optimization of nurses' enacted scope of practice as a strategy for improving clinical performance. New processes and resources that support full nursing scope of practice were developed. This project demonstrates that strategies focused on engaging clinical nurses can improve nursing practice.
Description: GIM ambulatory care nursing is complex and diverse and consists of registered nurses and licensed practical nurses, general and specialty care, and onsite and virtual care. The NPC experienced a lack of structure and unclear role expectations contributing to nurse disengagement. Leadership strategies to enhance nursing staff engagement are critical for improving performance. CNSs are educationally prepared to address gaps and improve patient outcomes in ambulatory care and within complex healthcare systems. Gaps exist in the literature regarding structure and design of a clinical nurse-led ambulatory care nurse practice committee. The objectives were to develop a new process to identify and resolve practice issues and identify strategies to build staff engagement. Clarification of committee role expectations, orientation to committee roles, and a targeted marketing strategy were developed to build engagement. A process was created to submit suggestions for practice changes electronically by situation, background, assessment, and recommendation (SBAR) format. Changes are addressed in three ways, among clinical nurses and managers, via a practice area workgroup, or via a multispecialty practice workgroup. Practice changes are shared with the GIM team by bidirectional communication and shared governance.
Evaluation/outcome: The redesigned GIM NPC membership consists of seven staff nurses in leadership roles as liaisons to clinical areas. The CNS and NMs serve as leadership advisors. In one year, nurses submitted 12 SBARs and completed nine SBARs, resulting in the development of electronic health record (EHR) nurse super users as a technology resource and a B12 administration toolkit supporting LPN administration, nurse engagement, and enhanced patient education. A multispecialty practice workgroup revised ambulatory care nurse education visits, conducted GIM emergency medical response training, and designed three interfacing digital platforms to store and provide access to resources. The GIM NPC promotes nurse engagement by building a culture of bi-directional communication, promoting nurse-driven ideas and solutions, and supporting GIM nurse and leadership partnerships to improve nursing practice, patient experience, and nurse satisfaction.