Top 5 Lessons Learned from a Pilot Ambulatory Care Nurse Residency Program

Purpose: The purpose of this evidence-based practice project is to share lessons learned and outcomes from a pilot ambulatory care nurse residency program (NRP). Estimates show a gap of 450,000 registered nurses (RNs) by 2025. Increased retention will build more robust pipelines for new RNs, especially in the ambulatory care setting where the workforce is traditionally older. Learning outcome for attendees include ambulatory care NRPs can be successful with ambulatory care-specific curriculum in collaboration with a systemwide NRP structure.

Description: In the current times of high RN turnover, many organizations use NRPs to support transition to practice of newly licensed RNs. In the United States, RN first-year employment retention is currently 67%. NRPs are proven to reduce turnover and sustain the RN workforce. Many organizations have not yet implemented NRPs in ambulatory care settings due to financial and operational challenges. Fiscally, each percent change in turnover costs healthcare organizations $380,600 annually. Organizations must focus on retaining early career RNs who are often the most likely to leave.

In 2021, a large health system in the northeast implemented a pilot NRP for 7 newly licensed RNs. As a healthcare system, the organization has had proven success implementing an in-patient NRP for over 20 years. However, until 2021, never implemented an ambulatory care NRP. This abstract depicts the top 5 lessons learned from the pilot ambulatory care NRP: 1) Established systemwide NRP curriculum is applicable to ambulatory care clinics. 2) Supplementary curriculum, including role of the ambulatory care nurse, population health, care coordination, preventative care, scope of practice, social determinants of health, and telehealth nursing is critical. 3) Autonomous role of an ambulatory care RN necessitates greater need for cohorted ambulatory care NRP model; all newly licensed RNs need to start together and have many opportunities for interaction considering geographical spread and limited number of RNs per practice. 4) Pre-scheduling NRP curriculum is necessary to facilitate attendance due to the autonomous nature and staffing challenges in ambulatory care clinics. 5) Established academic practice partnerships and increased clinical rotations in ambulatory care settings will feed a new to practice ambulatory care pipeline.

Evaluation/outcomes: 7 newly licensed RNs completed the ambulatory care NRP with a 100% retention rate. Nursing leadership is currently evaluating next steps of the pilot. In conclusion, implementing a program that takes nurses away from clinics may seem counterproductive while facing the workforce challenges. However, by proactive planning, ambulatory care clinics can offer this vital resource to first-year RNs.