1. Siaki, Leilani PhD, NP-BC, RN, FAANP
  2. Patrician, Patricia A. PhD, RN, FAAN
  3. Loan, Lori A. PhD, RN, FAAN
  4. Matlock, Ann Marie DNP, NE-BC, RN
  5. Start, Rachel E. MSN, NEA-BC, RN, FAAN
  6. McCarthy, Mary S. PhD, RN, FAAN


OBJECTIVE: The aim of this study was to evaluate scientific acceptability, feasibility, utility, and value of ambulatory care nurse-sensitive quality indicators (ACNSIs) in military outpatient clinics.


BACKGROUND: Optimizing healthcare quality and cost requires scientifically sound metrics. However, ACNSI development and measurement have lagged behind inpatient nurse-sensitive indicators. Validated and reliable ACNSIs are urgently needed to maximize nurses' efforts to improve healthcare quality.


METHODS: Two staffing and 4 patient-centered ACNSIs were pilot tested in 5 military clinics over a 6-month period using a mixed-methods design.


RESULTS: Reliability and validity were generally acceptable. Most ACNSIs demonstrated feasibility, utility, and value for performance measurement. Challenges to using ACNSIs include absence of standardized administrative and clinical processes, infrastructure, and leadership and technological support.


CONCLUSIONS: These ACNSIs show promise as valid performance metrics. Provider- and nurse-level metrics may synergistically improve practice, enhancing the team approach so critical to ambulatory care.