Using Institute of Medicine’s Future of Nursing Report as an Action-Oriented Blueprint to Strengthen Ambulatory Care Nurse Infrastructure

The 2010 Institute of Medicine’s foundational report on the future of nursing centered on several key areas for nursing practice: 1) nurses should practice to the full extent of their education and training; 2) nurses should achieve higher levels of education and training; 3) nurses should be considered full partners with physicians and other healthcare professionals; and 4) nurses are well-placed to support workforce planning and policy, especially regarding data collection and information infrastructure. The much-anticipated release for IOM’s 2020-2030 report will fully embrace a vision for nurses that calls them to lead change efforts and advance health with role empowerment and influence. Therefore, nurse leaders must clear a path that both supports and encourages autonomous decision-making, collaborative work, systems-thinking and research-grounded practice. The collective practice model for nurses must also support redesign work that is thoughtful and inclusive so that antiquated and rigid processes and systems are replaced with innovative, equitable, and more nimble health environments. Although a hefty lift and long road ahead, our organization’s leaders recognize the necessity of becoming a healthcare partner that constructs such a pathway for ambulatory care nurses.

In 2018, our newly erected center for advanced pediatrics consolidated several specialties and programs (more than 70 total). Our team of 2,600 physicians, 13 telemedicine, and 27 locations, and nearly 10 urgent clinics care for more than half a million children every year (we are the largest pediatric provider in our state and one of the largest in the country). Historically, we are an inpatient-focused system; only within recent years have we strategically grown in ambulatory care. During practice integrations and nurses transferring from inpatient to outpatient areas, a few key concerns consistently surfaced in feedback: 1) no formalized structure for professional practice; 2) disjointed communication from the system and between care team roles; 3) perception of system isolation (inpatient-focused events, learning, and recognition); and 4) little-to-no growth opportunity in existing nurse role.

This open dialogue offers us opportunity to begin foundational work around ambulatory care nurses and healthcare teams – specifically, creating a shared leadership infrastructure, hosting nurse cafes to socialize system initiatives, partnering with our research department to initiate projects and quality workgroups, and reviewing workforce, residencies, and professional development pathways (education-BSN and certifications).

Designing and implementing such a roadmap is difficult and inexplicably challenging in any organization! As leaders, we know placing infrastructure is only one part of addressing culture. We are required to encourage collaboration alongside self-efficacy, elevate voices, work with authenticity, and keep momentum. This presentation topic is both compelling and universally meaningful to AAACN conference peers. For the first time in our organization, we as ambulatory care nurse leaders have taken part in developing our system’s nursing strategic plan. We are so very excited about this work and the impact we will make. As we look to the future, achieving ambulatory care Magnet recognition (an impossible feat a few years ago) no longer looks like a Sisyphean exercise. We expect attendees to gain insight, receive examples of successful strategies, relate to and learn from our experience, and walk away energized for the work ahead.