Oncology care has shifted from the hospital inpatient setting to outpatient ambulatory care. Indications are that this will be a continuing and expanding trend for the future, increasing the need for ambulatory care nurses. Ambulatory care is complex and requires highly specialized nursing skills gained with education and experience. Most new graduate nurses are employed in acute care settings rather than ambulatory settings because they lack the skill set needed for ambulatory care. How can ambulatory care settings bridge the education and experience gap to fill this expanding need?
In their session on Thursday, April 11, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Debra Havranek, MSN, RN, OCN®, of Memorial Sloan-Kettering (MSK) Cancer Center in New York, NY, and Amanda Moorer, MSN, RN-BC, CCRN-K of UCHealth in Denver, CO, outlined their experience in gap education program development for new graduates and experienced nurses.
Experienced Nurses Need Telephone Triage Skills
MSK’s oncology ambulatory nursing program is a primary care model with individual nurses held responsible for working with assigned patients across the continuum of care, Havranek explained. Data showed that MSK nurses were transitioning to ambulatory nursing earlier in their careers rather than waiting for several years as in the past.
The team conducted a literature review of ambulatory care guidelines and scope and standards of practice to identify how to prepare transitioning nurses. They followed up with stakeholder surveys and focus groups and found a consistent theme: telephone triage was the most challenging element of transitional gap education.
To address the gap, they developed a two-day continuing education course to focus on consistency in the following critical competencies: telephone triage, effective communication, leadership skills, teamwork and collaboration, highly specialized skills, and astute critical thinking. Course topics included:
- Components of the ambulatory nursing role
- Effective collaboration and communication with patients, families and the interdisciplinary team
- Integrating patient engagement strategies
- Telephone triage
- Applying critical reasoning skills to symptom management and optimizing patient outcomes
- Mindfulness of patients with cancer and their caregivers
Education Program Onboards New Grads
Before developing a program to bridge the knowledge gap for new graduates in ambulatory care, Moorer explained that UCHealth conducted an ambulatory nurse residency program readiness survey and received 56 responses from 24 clinics:
- 70% reported difficulty in hiring RNs.
- 73% were interested or very interested in having new graduate nurses.
- 76% believed it would be beneficial or very beneficial to have new graduate nurses in ambulatory care.
- 57% indicated current clinic staff would be able to support new graduate nurses to be successful.
Because the institution had a need and was ready to meet it, adding ambulatory education and opening the program to new graduate nurses in a variety of care settings saw early success. Critical to the process, according to Moorer, was having a nurse educator in place in each department and involving the college of nursing faculty liaison and department’s RNs.
Each graduate nurse was given an organized schedule of experiences and competencies, and all completed a required evidence-based practice project. “The graduates brought a welcomed new enthusiasm to ambulatory nursing,” Moorer said. Cohort classes were small, but retention has been successful and future strategies are planned to ensure continued participation.
UCHealth learned the following lessons, Moorer said:
- It’s challenging to predict nurse resident need with the lower turnover rates and smaller RN workforce seen in clinics.
- Adding a clinical nurse educator to the nurse residency program advisory board may be helpful.
- Hiring managers should explain the ambulatory RN role to candidates during the interview process to align expectations.
Engage the clinic throughout each step of onboarding, orienting, and integrating new graduate nurses.