Harnessing the Nurse Voice and Multidisciplinary Collaboration to Revitalize Ambulatory Care Nursing Orientation

Our health system, like many others, has been compelled to prioritize our workforce’s well-being due to the rise in burnout as experienced across the industry. Impacted by the pandemic, much of the burnout in ambulatory care is related to increased demand for outpatient care. With a focus on clinician efficiency and streamlining workflows for providers, there is more reliance on ambulatory care nurses to help tackle growing outpatient care needs. The intensified need for telephone triage and asynchronous care highlighted a training gap for our nurses transitioning to ambulatory care. We saw this as an opportunity to support new hire nurses with a high-value, standalone clinical orientation targeting content specific to ambulatory care core competencies. This session highlights our innovative approach to training redesign to meet the needs of our nurses.

Leveraging a multidisciplinary team, we designed a new and comprehensive orientation curriculum. To ensure high value, a needs assessment was conducted surveying ambulatory care nursing staff and nurse managers. Baseline perceived value of the existing curriculum was also measured. We received responses from over 220 nurses (roughly 33% of recipients). The content topics in greatest demand from front-line staff were identified as EHR inbox management, care coordination, and telephone triage. Of note, this content had not previously been included in our orientation and is typically not part of pre-licensure academic nursing programs.

In alignment with our values as a Magnet-designated facility, workgroups including ambulatory care front-line nurses, managers, clinical educators, nurse informaticists, and EHR trainers were convened to craft a curriculum using scenario-based training to teach the high-impact skills requested by our nursing workforce. Foundationally based in the AAACN core curriculum, we launched our new orientation content in January 2023 and immediately embarked upon rapid continuous improvement cycles. Feedback is evaluated from each cohort and content continues to be adjusted as needed.

Just six months into deployment, perceived value has increased 30% over baseline. In addition to increased perceived value, qualitative data consistently indicates that participants are better prepared to confidently practice in ambulatory care clinics. Cohort feedback also regularly requests additional time in scenario-based training.

We continue to iterate the program based on our foundational principles of leveraging the AAACN core curriculum, considering direct nurse feedback, and multidisciplinary team collaboration. The program working group is also evaluating options to offer this content to existing ambulatory care nurses who may have never received this vital training.

Learning outcomes: 1) Demonstrate the importance of staff feedback in the development of a training redesign that meets the needs of unique clinical workflows. 2) Demonstrate the value of an innovative approach incorporating ambulatory care core competency focused training into nursing clinical orientation.