Bill Klaproth (Host): This is a special AONL podcast, as we speak with session presenters from the AONL 2023 conference.

With me is Patty Hughes, Chief Nursing Officer. We have Brittney Dees an Ambulatory Staff Development Specialist. Sara Wellman who is Clinical Nurse Specialist. And Marianne Hutti, who is a Nurse Scientist. We're going to be talking about their session today, Improving Ambulatory Outcomes. A CNO, CNS, Educator, and Nurse Scientist team.

This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Ladies. Welcome. Thank you so much for joining me. Looking forward to talking to you all about this. So we have a big group here, but Patty you're up first. You're going to lead us off. So let me ask you this. What is the compelling leadership issue or problem that your session addresses?

Patricia Hughes, DNP, RN, NE-BC: Thank you, Bill. So when you think about healthcare, generally people think about healthcare within the walls of a hospital, but there's so much more to healthcare than a hospital facility. And the four of us work in a large ambulatory facility. And when we looked at outcomes, nursing scholarship, standardization, it was very lacking on the ambulatory side. So the initial issue was standardization, common themes to ensure excellent patient outcomes. Because we want the same thing for our patients regardless of location in the healthcare facility. So that was the initial driver for the work that we have been doing.

Host: Okay. So let me ask you this Patty, let me stay with you, so you uncovered this, you talked about standardization, et cetera. So, when you found that out, what was your first step? What did, what did you, where did you think you had to go when you, when you learned that?

Patricia Hughes, DNP, RN, NE-BC: That's a great question. So I think my first step was shock and panic. Because I was you know, a nurse with about 25 years of experience. And I knew that the things that were going on in our ambulatory care environment were not the best things for our patients. And so I had to be very persistent. I had to engage stakeholders. So in an ambulatory environment, you work much more closely with providers or physicians than you do on an inpatient side. When you think of inpatient nursing, it's typically nursing. It's nursing that drives the care. In ambulatory, it's just the opposite. And so I had to involve stakeholders, and it's always really important to explain the why of anything that you do. So it, it, you know, involve them, involve my boss, surround myself with great people who had the same vision or a similar vision to mine.

Host: So be persistent. And you said you've got to engage the stakeholders and explain the why. So for a nurse leader, listening to this, got to remember those points. All right. So Marianne, learning all of this, what were the specific things you did then? What were the programs or policies that you put in place to address this?

Marianne Hutti, PhD, WHNP-BC, FAANP, FAAN: This goes back to Patty's leadership. She knew that she couldn't do it all herself. We have over a hundred clinics and many hundreds of employees in ambulatory. And so she was kind of a leader in terms of envisioning this team of the addition of three of us. With Sara as the Clinical Nurse Specialist, Brittney, as the Educator in the ambulatory space and myself as a Nurse Scientist. We were all hired right about the same time within about a year of each other. And then of course COVID hit. So that put a little damper on some of our beginning work. But it is through the work of the three of us together that we've been able to have some really excellent outcomes for our ambulatory spaces at UK Healthcare.

Host: So, can you explain some of the things that you, you specifically did?

Marianne Hutti, PhD, WHNP-BC, FAANP, FAAN: Sure. I mean, everything we do pretty much is within our team. So for example, when I first, I was the first of the three of us who were hired. And I tried very hard to engage the nurses in the clinic to increase scholarship. And I, I met with them. I went to all the clinics. I did all the things you're supposed to do, but it really wasn't until Brittney and Sara came on board, that I got the in that I needed with the nurses in order to encourage more scholarship. Britney was able to help us on the education side and identify deficits there. Sara was able to put me in touch with nurses who were interested in more scholarly activity. And between the three of us, we came up with some really good initial projects and continue to come up with initial projects that help to expand the care for our patients.

Host: Right. So Brittney, I'd like your thoughts on that too, from what Marianne said about what you put in place, I'd like to get your perspective on it, being the educator here.

Brittney Dees, DNP, RN, CPN: One of the most important things that we've done is standardization on the onboarding process. We've set some very important expectations on onboarding and ensuring that these orientees have preceptors that can train them appropriately. And really, onboarding them appropriately and putting the time into them, is what guarantees that we're going to have uh, safe patient care and good quality outcomes with our patients every day.

Host: Okay. And then Sara, if I could get your view, viewpoint on this as well.

Sara Wellman, MSN, APRN, FNP-C: Yeah. So my role is kind of the eyes and ears in the clinics. So, I round with the managers and the clinical staff. What are the gaps in care? What are the issues at hand? The processes that might not be working so well. And then I kind of bring that back to this group, you know, communicate with the chief nursing officer so that we can kind of develop a plan. What, what do we need to do to improve this process, improve this gap so that we are making sure that our patients are getting the best care. And, that our patient outcomes are improved. And so, I'll hook my nursing staff or my nurse managers. I'll connect them with Dr. Hutti to investigate, to research best practices and, and start that piece. And then also I work very closely with Dr. Dees, to push education and best practices and develop that piece of it.

Host: Absolutely. That sounds good. So, Brittney, let me ask you this. What happened then? Give us the story. What are the results? What's, what's happened since you've attacked this problem head on.

Brittney Dees, DNP, RN, CPN: Um, I would say overall we definitely have better trained staff and we are really looking at retention rates and how having staff that is trained and confident in their role, how that kind of keeps them in the organization and in their clinics. We also have more employee engagement. Um, they want to be involved in decisions that affect their work every day. So those have been the biggest things that I've seen and we have staff that are really looking for professional development opportunities as well. And I serve kind of as a resource for that and building them professionally.

Host: Patty, let me ask you, what are your thoughts on the results? The outcome of this?

Patricia Hughes, DNP, RN, NE-BC: Well, I think, my team that's sitting here is being, a little timid about their successes, in that we know that there's many quality metrics in ambulatory like bmi, blood pressure readings, depression screening. These are all extremely important in our society to ensure that our patients are getting the care they deserve. And it's through this team that we've been able to uncover those gaps and implement strategies that standardize the work for every single employee in the ambulatory care environment. So whether they're in a primary care clinic or a specialty care clinic, they know the work that needs to be done. So that every patient is touched by, by all of their work. That's just a few of the things that we've accomplished. I mean, there's a, there's a list of things. I'm extremely proud of this team, because of the diligence that they implement in ensuring, uh, good quality.

Host: Thank you for that. And Marianne, how about you?

Marianne Hutti, PhD, WHNP-BC, FAANP, FAAN: Well, I started out with things and I continue with things like when Brittney or Sara are creating projects, I can assist that by doing literature searches. I can help by helping to create outcome measures or ways to, to evaluate what they're doing. In addition to that, I've been working with the nurses in the clinics and last year we had 18 quality improvement projects. We had, we have two research projects that are ongoing and we have made numerous national presentations in this particular year. So we've been able to showcase what we are doing at a national level as well, and most of these nurses had never presented anywhere before, so it's really exciting for me to see them blossom in that way.

Host: Yeah, I bet. Absolutely. So as we think about this, for a nurse leader listening to this, Marianne, to you, in your role as the nurse scientist, what is your key takeaway, the key point for someone to remember about what you've accomplished?

Marianne Hutti, PhD, WHNP-BC, FAANP, FAAN: I think all of us would make change if we've worked in isolation, but we make better change and more impactful change by working together. You know, it's, it's the whole thing of putting lots of brains together. You get better outcomes.

Host: That is a great point for, for anybody in any business. So that's a great point. And Patty, you're our CNO. How about you? What is the key takeaway from your point of view?

Patricia Hughes, DNP, RN, NE-BC: I think, what I said in the beginning, be persistent, keep the patient at the center of everything you do, understanding that, you know, my job is to ensure that the patients get what they need and then to surround myself with really, really good people.

Host: Another great point. Brittney, how about you? Your key takeaways?

Brittney Dees, DNP, RN, CPN: I think for me, everything that I do in my role is about investing time in the employee, and I think that that's an important first step is to invest that time in the employee so that they are happy and they come to work to take care of the patients every day, which is what we want to do, is take care of those patients and give them good outcomes.

Host: Absolutely. And Sara, how about you?

Sara Wellman, MSN, APRN, FNP-C: Well, they stole all my good answers. No, I think, um, there's a couple of points. Um, collaboration, as we've said, communication, and then just being present as a leader, being present in the clinic with the staff, with the managers, listening, really putting on those listening ears and being there for them and to support them.

Host: Yeah, that makes a lot of sense. Okay, well I want to thank you all for your time. This has been great. If we could just do a, a wrap up, just final thoughts. I know you just gave me your key takeaways, but overall, your final thoughts of this. Marianne, let's start with you.

Marianne Hutti, PhD, WHNP-BC, FAANP, FAAN: I guess my final thought is that for this project, and every project in nursing, nursing is a team sport. And you can't be a good nurse without being part of a team.

Host: Yep, that is true. And Patty, as we wrap up talking about improving ambulatory outcomes, final thoughts from you?

Patricia Hughes, DNP, RN, NE-BC: My final thought for any nurse leader would be to ensure that you understand the strategy and to engage with nurses and non nurses to ensure that they understand the strategy as well. Because you need those business minds to oftentimes push your own agenda forward. It's extremely important. I'm very fortunate. I have a CAO or a chief ambulatory officer who like my work husband, he, he and I, uh, finish sentences for each other. But I think you have to ensure that everybody's on the same page moving forward.

Host: Yeah, so true. And Brittney, as our educator, your final thoughts on improving ambulatory outcomes.

Patricia Hughes, DNP, RN, NE-BC: I think look at every day as a learning opportunity. I learn something new in my role every single day and every time I go into a clinic, it's a learning assessment on what the needs are for the clinical staff. Really take the time to understand the problems and then be able to come up with a solution to ensure that we are giving them everything that we can.

Host: Yeah. Thank you for that. And Sara, uh, final thoughts from you?

Sara Wellman, MSN, APRN, FNP-C: I'm gonna go back to collaboration. Learning to play well with others and communication uh, just am so proud to be a part of this team. It is definitely in my career, the best part, where I am now, and it's because I have such wonderful collaboration with this team.

Host: Absolutely. Well, I want to thank you all for your time today, Marianne, Patty, Brittney, and Sara. Thank you so much for your time. This has been great.

Brittney Dees, DNP, RN, CPN: Thank you.

Patricia Hughes, DNP, RN, NE-BC: Thank you Bill.

Sara Wellman, MSN, APRN, FNP-C: Thank

Host: you.

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Thanks for listening.