Silos No More: Ambulatory Care Nursing Grand Rounds Adding Value for True Clinic Collaboration

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.