Different Strategies Needed for Orienting New Graduates and Experienced Nurses to Ambulatory Oncology

April 11, 2019

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 (https://congress.ons.org), 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:

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:

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:

Engage the clinic throughout each step of onboarding, orienting, and integrating new graduate nurses.

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