ambulatory care, clinical nurse specialist, continuum of care, population health, primary care, rural health, vulnerable populations



  1. Urton, Michael S. DNP, APRN, AGCNS-BC
  2. Reis, Pamela PhD, CNM, NNP-BC, FACNM
  3. Cowin, Pamela Bailey PhD, RN
  4. Linder, Julie Michelle DNP, MSA, APRN, ACCNS-AG, CCRN-K


Purpose: The purpose of this project was to develop an ambulatory clinical practicum for clinical nurse specialist (CNS) students in rural and underserved Eastern North Carolina.


Description of the Program: A 14-week clinical practicum was designed for CNS students who participated in a Health Resources and Services Administration Advanced Nursing Education Workforce grant-sponsored program entitled "Advanced Practice Registered Nurse RURAL Scholars Program." The objectives of the clinical practicum were to increase student competence in ambulatory care, identify critical knowledge and competencies in CNS ambulatory care, and determine potential opportunities for CNS practice in ambulatory settings.


Outcome: Students demonstrated increased awareness and interest in specific health challenges faced by rural and underserved communities and became aware of services available for individuals with complex healthcare needs. Deficiencies in the CNS curricula regarding ambulatory care were identified by students. Although the value of the CNS in ambulatory practice was appreciated by students, staff, and preceptors alike, opportunities for employment in ambulatory settings in rural and underserved communities continue to remain a challenge.


Conclusion: Student experiences in an ambulatory care CNS clinical practicum support the need for the development of knowledge and competencies in ambulatory care that will allow for the expansion of CNS practice in rural and underserved communities.