Would a One-Year Ambulatory Care Specialty Transition-to-Practice Program Prepare New Graduate Registered Nurses for Success in the Outpatient Clinical Setting?

Learning outcome: Poster presentation learners will identify innovative strategies to address the ambulatory care nursing shortage.

Purpose: Over the last two decades, visits to ambulatory care facilities have steadily increased. As a result, there is a need to increase the ambulatory care workforce, including registered nurses (RNs). Experienced RNs have long been the preferred choice for hiring in the ambulatory care clinical setting. Given the nurse shortage exacerbated by the COVID-19 pandemic, ambulatory care leaders recognized the need to increase the proportion of new gradate registered nurses (NGRN). The purpose of the project was to create an innovative and effective transition-to-practice (TTP) program for NGRN and nurses transitioning from other specialties called transition fellows (TF).

Description: To facilitate an effective TTP program, nursing professional development specialists (NPDs) at a large urban pediatric hospital, developed a one-year ambulatory care specialty TTP program to address the immediate need for RNs. This program entailed a 9-week immersion period that included ambulatory care-specific didactics, preceptorship, shadowing opportunities with interdisciplinary team members, and debriefing sessions. Literature review also provided well-supported evidence that academic partnerships enhance ambulatory care training. Therefore, the NPDs leadership team advocated for the participation in a state-wide comprehensive ambulatory care-specialty RN apprenticeship program. This collaboration provided a well-rounded combination of instructor-led and asynchronous course work. Specific skills emphasized for ambulatory care NGRNs included care coordination, telephone triage, and leadership. Additionally, clinic-specific competency development aided in enhancing each NGRN's clinical practice over the one-year program. Interactive activities such as simulation and roleplay were incorporated in clinical skill stations focused on outpatient medical emergencies, de-escalation, and crisis prevention scenarios.

Evaluation/outcome: The initial two NGRNs have completed the inaugural program and one TF successfully transitioned to ambulatory care nursing. Currently, one NGRN is enrolled in the second cohort. Retention 18 months after program completion is 100%. Clinic-specific didactic class evaluations indicated that topics presented were relevant to practice. The participants demonstrated improvement in their critical-thinking by navigating from being task-oriented to performing autonomously in a fast-paced ambulatory care setting. Participation in an evidence-based practice (EBP) project promoted teamwork, ambulatory care needs assessment, and process change recommendations. The new TTP program enhances manager and preceptor collaboration in creating a successful learning environment, in addition to establishing collaborative partnerships. Through strategic planning, NPDs paved the way for a program that prepares ambulatory care nurses to provide high-quality care to specialized pediatric patient population.