Structured Ambulatory Transition-to-Practice Orientation Programs Improves Care Delivery

Purpose: To facilitate the successful transition of RNs from the inpatient to the outpatient setting through evidence-based education that prepares the RN to practice competently and safely in ambulatory care services with improved job satisfaction.
Description: Insufficient orientation experiences often contribute to increased turnover rates for RNs transitioning to ambulatory care services from the inpatient setting, which can compromise the ability to deliver competent and safe patient care. The American Academy of Ambulatory Care Nursing (AAACN) identifies two major trends demonstrating the need for ambulatory care transition-to-practice (ATTP) programs: 1) leaving the job - experienced RNs new to ambulatory care environments return to previous work due to unrealistic expectations and lack of understanding of the interprofessional approach in ambulatory care and 2) complex health care needs - in the US, 1 in 4 adults have 2+ chronic conditions that are managed in an outpatient setting.
RNs in ambulatory care must demonstrate competencies in guiding and teaching patient self-care management and healthcare navigation, which can be facilitated through a structured evidence-based onboarding experience. A pre-assessment was conducted of organization results from the 2018 Press Ganey Workforce and Engagement Solutions survey. One question became the focal point for the ATTP program due to marginal results, “I get the tools and resources I need to provide the best care/service for our clients/patients” (Adequacy of Resource Staffing). As a result, an online stakeholder needs assessment survey (SNAS) was conducted of managers and front-line RNs in ambulatory care services across the system. The survey consisted of 15 questions that utilized the 2017 AAACN Transition to the Specialty of Ambulatory Care and Vizient curriculum guidelines. The survey compared the leadership perception of a new RN’s ability to practice competently and safely versus the front-line nurse’s perception of their own competence and safety practices. Once the data was sorted, a team of stakeholders collaborated to create a program tailored to organizational and learner needs.
Evaluation/outcomes: ATTP launched its first class in January 2019. As of August 2022, (46) groups (~545 RNs) have completed the program. We saw a 15% increase in response to the question, “I get the tools and resources I need to provide the best care/services for our clients/patients” (Adequacy of Staffing Resources). On a broader scale, 62% of managers and 85% of RNs reported ATTP specifically assisted the RN to care for patients more competently and safely. To further determine the validity and quality of ATTP, a repeat SNAS is disseminated to managers of new hires and RNs who complete the ATTP program. Results from this SNAS revealed 58% RNs and 74% managers reported ATTP increased job satisfaction. Additional results obtained through the SNAS will assist stakeholders in making adjustments to the curriculum to further achieve program goals.