Date of Award

6-11-2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Kathy Bobay

Abstract

ABSTRACT Background The United States healthcare system underperforms compared to other industrialized countries where cost and quality are concerned. Nursing is accountable, as a profession recognized by society, to ensure health and livelihood in the patients and populations served. Advancing the role of the ambulatory care nurse and providing valid strategies to measure the contribution of the nursing profession in this setting is a tactic that many organizations are pursuing to achieve this paradigm shift. The assessment of relationships between measures of structure, process, and outcome within the ambulatory care setting across a variety of organizations may have the potential to lay the foundation for further studies that will inform the nursing profession of continued need for development in this critical transformative moment in history. Methods This study was conducted with a quantitative, non-experimental, descriptive, correlational design. The research question proposed in this study is, “Do relationships exist between ambulatory nursing quality indicators that are structure related, process related, and outcome related?”. The objectives of this study were to determine indicators that are sensitive to the role of the RN in ambulatory and to determine indicators that are highly related with each other within the paradigm of structure, process and outcome in the ambulatory RN environment. Results Descriptive analysis was achieved by Aim 1 of this study, describing structure, process and outcome variables in the ambulatory care environment at the unit level of measurement. Alternative hypothesis that relationships existed between these domains of measures was supported in Aim 2. The RN was not found to be related, when assessed from the unit level, by visits, to process or outcome variables. The MA was the most significant and positively related to process and outcome variables in Aim 2. Conclusions This study was conducted in a sample size of 130 primary care clinics, when the originally intended sample size was 385. Furthermore, many challenges existed to acquiring all data points requested from participants. While description and some relationship was successfully achieved, more research will be needed, and potentially from the patient level of data analysis to understand more fully the most effective staffing models for optimal patient care outcomes.

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