Nursing practice in ambulatory care: View of the staff nurse

Nurses play an increasingly important role in a variety of ambulatory cancer settings as part of the multidisciplinary team (Paschke, 2006). Despite the rapid growth in registered nurse employment in ambulatory care settings, the nurse role and contribution in ambulatory care is the least studied (Swan, Conway-Phillips, & Griffin, 2006). Exploring the expert practices of nurses in ambulatory settings contributes to the understanding of the value of nurses and has the potential to positively impact patient outcomes. The purpose of this hermeneutic phenomenology study was to describe the unique value and skills of expert nursing practice in ambulatory care settings.

Purposive sampling was used to recruit nurses with five years or more experience in ambulatory care, employed in a tertiary care cancer setting having over twenty separate outpatient clinics. Twenty-one nurses with at least five years ambulatory care experience participated in one of four focus group discussions. A semi-structured interview was used to elicit data. Effort was made to recruit nurses representing the ethnic mix of the metropolitan cancer center's nurse employees.

This research is apparently the first effort to understand the attributes of expert nursing practice in an ambulatory oncology setting. The concept of the hermeneutic circle guided data analysis. The forward arc of the circle, based on the researcher's preconceived ideas or knowledge, served as the "horizon" (in Heidegger's terms) and the return or backward arc as the openness and uncovering that reshaped understanding. Examination of the data from the focus group discussions revealed the over arching theme of ambulatory care nurses as the journeyer, being with their patients on their illness journey. Five themes emerged, reflecting expert ambulatory nursing practice and supporting the over arching theme of the nurse as journeyer: being a content expert, creating positive relationships, listening with attuned skill, advocating for the patient, and developing long-term patient/family relationships. Implications for nurse managers, ambulatory care nurses, and nursing staff development educators promoting nursing expertise in ambulatory settings are described.