Transformation and development of the role of the professional nurse in an ambulatory care setting

Purpose:
The nursing committee structure promotes representation from all settings. Nurses representing the primary care network voiced concern with the application and dissemination of information. A shared governance model specific to the role of the ambulatory care nurse was planned and implemented.

Significance:
Healthcare organizations are shifting services from inpatient to outpatient. This shift in response to needed reform is redefining the role of the professional nurse. The Magnet model provides the framework for outpatient settings to transform the role of the professional nurse.

Strategy and Implementation:
A task force of nursing representatives from all network sites and nurse managers were tasked with creating a shared goverance model specifically to address the issues and processes in this setting. The model developed mirrored the organization's shared leadership structure. Committees to address magnet culture, education and policy and procedure were formed. The chair of these committees would also sit on the organization's corresponding committees. The task force also instituted a Network Practice Committee. Membership on this committee would be a representative from each site. This committee would be charged with standardizing best practice throughout the network. Analysis of patient satisfaction, RN satisfaction and outcomes of site specific practice committees would guide improvement efforts.

Evaluation:
The NDNQI RN Satisfaction Survey indicators for decision making, autonomy and professional status were chosen as the measures of success. Scores decreased from 2008 to 2009. In 2010, survey scores increased and were above the benchmark mean T-Score for like units in all hospitals.

Implications for Practice:
The role of the professional nurse in an ambulatory care setting is critical to the response of organizations to healthcare reform. Professional nurses will be the driving forces for patient-centered medical homes. The Magnet Model provides the framework to for this transformation.