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Requirements for hire - Primary Care clinic nurse

  • 1.  Requirements for hire - Primary Care clinic nurse

    Posted 07-20-2022 11:46

    In your professional opinion, do you believe a primary care clinic nurse requires in-patient experience before entering the ambulatory care setting? If so, how much and what type specifically? If not, what experience do they need (if any at all)?

    Finally, do other respected nursing organization (like AAACN) have any standards for job description/experience requirements to ambulatory care nurses in primary care?



    ------------------------------
    Kenzo Sanga, MSN, RN
    Director of Outpatient Clinical Education
    Phoenix, AZ
    480-788-6406
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  • 2.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-21-2022 06:09
    I have heard arguments for both sides. Personally I don't think I could have switched to ambulatory care nursing if I didn't have the inpatient experience. I worked mainly in CCU and ICU. I gained a lot of critical thinking that I know helps me in the family practice I work at on a daily basis, especially when I do triage calls. My inpatient experience is also a big help when I do hospital follow up calls since I know what these patients have been through and what questions to ask. I am very familiar with all kinds of medications and  lab and radiology tests these patients have received. I really could go on and on but I will spare you all lol.


    Sent from Yahoo Mail for iPhone



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  • 3.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-22-2022 05:37

    Good morning-

     

    I do not require inpatient experience for a primary care position. For some nurses it can be helpful for triage-but on the chronic disease management side of things, that is really very new even for the inpatient nurse. Most are not aware of payment regs-for example, how many test strips are covered by insurance, how to get diabetic shoes approved, and how to use ongoing motivational interviewing for incremental lifestyle changes.

     

    I have had challenges with hiring some nurses with inpatient experience. Some came from hospital settings that did not well use protocols and order sets-and so the nurses can at times wait for the providers to give them direction instead of functioning more independently. This is difficult to teach if the work culture they have been in the whole time has been one of asking permission.

     

    I find that new grads actually do quite well, and take a fair bit of those, particularly ones that know they want this setting (as I do not have a requirement for acute care experience before coming to primary care). Given it is a different approach and slight shift in thinking with the care delivery model, it is nice to get nurses who are excited/committed, and also without a set-in-stone paradigm of care. These folks are actually some of my most successful nurses, and the ones who stick around because they chose this field in the first place.

     

    Happy to talk more-my email is: mary@chc1.com

     

    Best regards,

    Mary

     

    Mary Blankson, DNP, APRN, FNP-C, FAAN

    Chief Nursing Officer

    Community Health Center, Inc.

    675 Main Street,

    Middletown, CT, 06457

    Cell: (860)227-5432

    mary@chc1.com

     

    This message originates from Community Health Center, Inc.. The information contained in this message may be privileged and confidential. If you are the intended recipient you must maintain this message in a secure and confidential manner. If you are not the intended recipient, please notify the sender immediately and delete all copies of this message. Thank you.




    Original Message


  • 4.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-24-2022 09:12
    Hello,

    I speak in this topic all the time with my managers.  I have worked in nursing for more than 30 years. At one point it was a requirement to have worked a minimum of 1-2 years in Med/Surg to be able to apply and work in ambulatory care.  The clinical knowledge and critical decision-making skills are essential to work in Ambulatory care, as they are the same in-patients.  I find that nurses who do not have these skills, it is very challenging to educate them on the rationale of quick and critical decision making, as well as, clinical skills in assessments and triage.  I support nurses having worked in-patient (med/surg, ICU, PACU or ED) before working in Ambulatory Care.  The quality of education and patient support towards their most optimum wellness is fostered by quality nursing.

    Robin Ravenel
    Director of Nursing
    New Milford, New Jersey




    Original Message


  • 5.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-24-2022 09:08
    Hello,

    I speak in this topic all the time with my managers.  I have worked in nursing for more than 30 years. At one point it was a requirement to have worked a minimum of 1-2 years in Med/Surg to be able to apply and work in ambulatory care.  The clinical knowledge and critical decision-making skills are essential to work in Ambulatory care, as they are the same in-patients.  I find that nurses who do not have these skills, it is very challenging to educate them on the rationale of quick and critical decision making, as well as, clinical skills in assessments and triage.  I support nurses having worked in-patient (med/surg, ICU, PACU or ED) before working in Ambulatory Care.  The quality of education and patient support towards their most optimum wellness is fostered by quality nursing.

    Robin Ravenel
    Director of Nursing 



    Original Message


  • 6.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-21-2022 08:49
    I have seen new grads be successful in ambulatory care as their first job - one in oncology infusion and the other in family medicine triage. In both cases, they had pre-licensure exposure to the clinic setting (clinical rotation/preceptorship). They also both had a deep personal interest in their specialties and believed it was where they were meant to be. AAACN published guidelines for academic-practice partnerships in ambulatory care earlier this year. Those guidelines present a strong case for building a pipeline of nurses who are ready for ambulatory care through having ambulatory care clinicals prior to graduation. I'm not saying every new grad nurse would be a good fit for ambulatory care straight out of school, but it can work for some.

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    Elizabeth Fritz PhD,RN,NPD-BC
    RN Program Manager, Clinical Education
    SSM Health
    Watertown WI
    (608)260-6467
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    Original Message


  • 7.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-21-2022 10:06

    Hi Kenzo!

    I recently retired as Nurse Manager of a very busy, private travel health clinic.  We had FT, PT, and temp staff (I'm now remotely supporting transitions into a new EHR).  I believe every nurse needs at least 1-2 years of med-surg experience.  I've seen each of us bring the strengths and experience forged in Med-Surg into the ambulatory clinical setting. In-patient nursing experience teaches some skills that can be a challenge to acquire otherwise.  I made it a point to explore each applicant's med-surg experience to better understand the unique perspective and skills she brought to the team.    Having said that, I understand Dr. Fritz's perspective of stronger pre-graduation clinical experience supporting transition for new grads directly into ambulatory care.  The one nurse who acclimated the fastest of any team member (ever, no exaggeration) came to us with some previous in-patient experience, but came directly from two years in a phenomenally busy stand alone birthing center.  



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    Shelley McCord, BSN, RN-BC
    Manager, Clinical Nursing
    International Mission Board/SBC
    Richmond, VA
    804-620-3818
    smccord2@imb.org
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    Original Message


  • 8.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-21-2022 14:00
    We have had both in our FQHC. It's definitely a different onboarding experience for each of them. Our local nursing school is working to elevate community health in their program and we take senior nursing students who end up staying with us about 50% of the time and they are great nurses. It's always nice to get experienced nurses but we also value new RN's that have a passion for the work we do. We do not allow new grads to work in a site without another nurse, in our School Based Health Centers or mobile health centers.  Our SBHC nurses are required to have a minimum of 2 years experience.

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    Rebekah Sherman
    Director of Nursing
    La Clinica de Valle
    Medford OR
    (541)221-3040
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    Original Message


  • 9.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-22-2022 07:34
    Edited by Lindsay Miller 07-22-2022 07:34
    I have thought a lot about this and my thinking has shifted over the years for many of the reasons suggested by Mary Blankson above. It is not common practice at the organization I work at to hire new graduates in ambulatory, but I am thinking this will shift over time at many places in the future. I recently listened to a great module (if you have access to Lippincott learning) called "Cornerstones for a Successful Ambulatory Nurse Residency Program". It was very enlightening and discusses how they used the new graduate practice gap when building their ambulatory nurse residency program. They incorporated a rotation (I believe 6 weeks) of inpatient work into t nurse residency. Although their sample was small, they had a 100% retention rate and the managers were very happy with their hires and the program!

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    Lindsay Miller MSN, RN, AMB-BC
    lmiller3@metrohealth.org
    RN Ambulatory Float Pool
    The MetroHealth System
    Cleveland, Ohio
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    Original Message


  • 10.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-22-2022 10:06
    Kenzo, 
    I've been working with some local colleges to consider providing RN clinical rotations in primary care for their students at our sites.  I'm hopeful we will have our first students in the next academic year. 


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    Peter DiPiazza DNP APRN BC-FNP
    Director, Clinical Practice and Performance
    MCMG
    Upper Arlington OH
    614-338-9158
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    Original Message


  • 11.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-25-2022 10:18
    I would agree with the comments that have already been made.  Traditionally, as I started out in professional development roles, I would have been a strong proponent of any new graduate nurse having at least a year in med-surg nursing.  As our landscape has shifted and nursing grad preferences have changed, I have needed to evolve in my thinking.  My advice now to new grads thinking about this is that if they do choose to go into a specialty area directly upon graduation is to choose an organization to work in that is going to give an extended orientation or a new grad fellowship or internship, so that those critical thinking skills can be developed.  This is a credible alternative to that  med-surg experience.

    My advice to ambulatory areas who would want to consider hiring new grads is that to be fair to them, and to improve your chances of retaining them as ambulatory nurses, you develop an orientation program in an extended format  for them in the form of an internship, fellowship, etc.  These new graduates will have to be supported in ways that an experienced ambulatory nurse would not need.   I would also make an argument that a nurse coming to ambulatory experienced in acute care should also have some additional orientation time and content that would help them to transition to the new practice environment.  It would not need to be as extensive as content for a new grad, but it should be broader than just the traditional orientation for your experienced ambulatory nurse.  You could strategically position this as both a recruitment and a retention strategy for your organization.

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    Phyllis Miller, MS, RN, NPD-BC, FHCE
    Nurse Manager
    Inova Physician Services
    Fairfax, VA
    703/407-5833
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    Original Message


  • 12.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-26-2022 08:33
    Edited by Adina Steen 07-26-2022 08:34
    I'd like to add my two cents. As a new grad in 2014, I immediately went into a specialty ambulatory care practice at a highly regarded facility. At the time I wasn't sure if I was doing the right thing, but over time I learned that I love ambulatory care - the managing of chronic conditions, the relationships you form with patients, the slower pace than the hospital setting, etc. I also learned that I quite enjoy and am good at phone triage, which they don't teach in nursing school, though they absolutely should. Med/surg skills vs ambulatory skills are simply different, that's all. Not every nurse needs ALL of the skills.

    I think the attitude is shifting and med/surg, or any acute care setting, is not for everyone. There are so many ways to be a nurse and med/surg is only one way. I stayed at that job for 7+ years and only changed because I moved.

    I find this topic very interesting!

    -Adina Steen, RN, BSN, AMB-BC


    Original Message


  • 13.  RE: Requirements for hire - Primary Care clinic nurse

    Posted 07-26-2022 11:10
    I don't think there is any reason to require inpatient experience.  Any nursing experience does help the transition but what I have found to be more important is the individuals personality and attitude.  I have had a lot of success with new graduates in the ambulatory setting and unsuccessful with nurses with inpatient experience.

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    Ryan Taylor MSN, RN, CPN, NE-BC
    Director of Medical Practice Management
    Memorial Hospital and Health Care Center
    Jasper, Indiana
    812-996-8489
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    Original Message


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