Research Suggests New Nurses Could Help Address the Ambulatory Staffing Issue

March 10, 2020

By Deena E. Gilland, DNP, RN, NEA-BC, FAAN 

Deena E. Gilland, DNP, RN, NEA-BC, FAAN
Deena E. Gilland, DNP, RN, NEA-BC, FAAN

As use of ambulatory care settings continues to grow, so too does the demand for expertly trained nurses to staff them. Unfortunately, nurse staffing levels have struggled to meet the burgeoning need in ambulatory clinics throughout the country. Traditionally, undergraduates receive limited ambulatory-specific education in nursing school, leaving them unprepared to enter those settings after graduation. However, the nursing shortage complicates staffing issues, and we must develop programs to direct new graduate nurses into ambulatory oncology careers.  

Practice required a paradigm shift to encourage and prepare incoming graduate nurses to step into ambulatory roles. Emory Healthcare, in conjunction with the Emory Nell Hodgson Woodruff School of Nursing, added ambulatory nursing to all BSN curricula and developed the ambulatory nurse residency program (ANRP) to meet that need. The program offers focused education, trained preceptors, a supportive infrastructure, and experienced ambulatory nursing staff serving as mentors to prepare graduates to meet the needs of the complex outpatient cancer care setting.  

To measure ANRP outcomes, the team looked at how many graduates would stay in the ambulatory setting after completing the program’s first year as well as nurse competency, professional satisfaction, communication, and stress level. Because it was a novel approach, the team set an achievable goal: to retain and onboard at least one nurse through the program.  

After great initial interest, the program maxed out at 11 total cohorts for its first year with a 94.6% retention rate at year one. Through ANRP’s 2.5-year tenure, 32 total nurses have successfully completed and stayed in the ambulatory setting. Only three nurses have left the program, all because of out-of-state relocations. Although the sample size is small, the message suggests that focused education and training for nurse graduates can prepare them for a career in ambulatory care.  

When working with institutional stakeholders to develop programs like ANRP, highlighting the value of building a workforce pipeline for ambulatory nurses and encouraging a paradigm shift at the institutional level is critical. Leverage national organizations like ONS and the American Academy of Ambulatory Care Nursing to find helpful resources, information, and ideas to address ambulatory staffing issues at your institution.  

Ultimately, nurses are the front line of patient care, and all healthcare settings must be appropriately staffed with well-trained, prepared nursing professionals. By tapping into the new graduate pool of nurses, ambulatory clinics can implement novel ways to overcome staffing issues, onboarding nurses to meet the challenging, complex needs of patients with cancer in the outpatient setting.  


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