The following article features coverage from the Oncology Nursing Society (ONS) 2019 Annual Congress. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

ANAHEIM, CA — A comprehensive clinical orientation using evidence-based nurse residency program (NRP) curriculum and rotations in various ambulatory services can improve new graduate nurse satisfaction, learning experience, and retention rates, as well as increase the competency of nurses in the ambulatory oncology setting. The findings were explained in a poster presentation at the Oncology Nursing Society (ONS) 44th Annual Congress.

Advances in cancer treatment, as well as health care reform, are shifting the delivery of oncology care from the acute setting to ambulatory settings. In addition, both the general and nursing population are getting older; the former creates an increase in demand for oncology care while the latter reduces the number of experienced nurses due to retirement.

The combination of these factors create the need for — and an opportunity to train — new graduate nurses in the ambulatory oncology care setting. Nurse residency programs (NRPs) are proven to improve nurses’ ability to organize, manage, and communicate patient care complexities and develop hands-on skills. However, as acknowledged by the National Academy of Medicine (formerly known as the Institute of Medicine), traditional NRPs for ambulatory care areas are an insufficient model; implementing an ambulatory-specific NRP is recommended.

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To this end, researchers integrated an ambulatory care curriculum into City of Hope’s inpatient NRP to provide training in the ambulatory oncology care setting that is as robust as the training in inpatient care. The research was led by Janna Alyu, MSN, RN, OCN®, of City of Hope National Medical Center in Duarte, California.

Using feedback from clinical nurses, nurse leaders and educators integrated learning objectives from the Vizient™/AACN ambulatory care curriculum into the didactic and practical portions of the existing inpatient NRP. Ambulatory-specific considerations were included in lectures, ambulatory scenarios were included in case studies or simulations, and ambulatory nurse residents rotated through their designated clinic (solid tumor, hematology, or a mix of the two). Ambulatory nurse residents also attended ambulatory-specific presentations at specific points of the program.

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In addition to preceptorship in their designated clinic, ambulatory nurse residents were rotated through different ambulatory departments and the inpatient setting to build their understanding of the care trajectory of a patient, cancer treatment modalities, and the various services available to patients with cancer.

The first cohort of 5 ambulatory nurse residents participated in a focus group to evaluate their learning experience. The cohort reported that the clinical orientation provided a better understanding of available ambulatory services and the overall process of delivering integrated and coordinated care to patients.

The researchers also surveyed the 17 participating ambulatory services. Of the 11 responses received, most reported satisfaction with the orientation experience and are likely to collaborate with the NRP in the future.

The ambulatory curriculum was integrated into the NRP in January 2018. The retention rate of ambulatory nurse residents is now 88%, due to one voluntary resignation.


Alayu J, Gee N, Shamai J, Okamoto C, Rice D. Integration of ambulatory curriculum into a nurse residency program. Poster presentation at: ONS 44th Annual Congress; April 11-14. 2019; Anaheim, CA.