Demonstration of the Value of RN Front Line Leaders in Ambulatory Care

Purpose:
Demonstrate the value of Front Line Registered Nurse (RN) leadership in ambulatory to influence quality and cost effectiveness. Utilize a nurse sensitive indicator to influence shifting the care model of isolation to one of collaboration across multiple hierarchies with established boundaries.

Relevance/Significance:
Traditional models of primary care have been physician owned and directed. In today's world increasing challenges of greater complexity of patients in primary care, changing economics due to health care reform and pressures of increasing competition require a new model in the fast paced rate of change. The Registered Nurse unique preparation resulted in sustaining changes in meeting organization performance expectations, blending business and quality goals through new partnerships and skills.

Strategy and Implementation:
Our goal initially was to support staff in 40 ambulatory practices design, implement and sustain an Ambulatory Fall Prevention Program. Registered Nurses in ambulatory primary and specialty care practices often have realistic ideas on improving care but often do not know how to effectively implement the change especially in a large health care system. Initial efforts were aimed at supporting Lead RN professional development. This often required the RN quickly learning new technology, processes, and communication strategies across multiple disciplines and levels of the organization. In addition the Lead Nurses developed expertise in process improvement, data reporting and use of technology to support consistent documentation of newly developing standards. Since the 40 Lead Nurses worked in distant practice settings in two states new methods of meeting and sustaining the program needed to be learned. Data helped to drive measures of success and change the mind set of many partners.

Evaluation:
At the onset of this program little evidence existed for ambulatory fall prevention. Types of preventable falls were identified, prevention strategies with new standards of care were implemented. Some examples of outcomes were reduction of falls by 1% from exam table, 5% from step stools, and 4% from waiting room. We had ten post immunization falls and prevented four.

Implications for Practice:
Ambulatory Front Line Registered Nurse Leadership value was demonstrated through data driven quality initiatives leading to improved patient outcomes. Continued demonstration of the value of RN leadership in ambulatory is critical to blending the business model with patient and organization goals.