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ORCID
http://orcid.org/0009-0008-7540-3978
Date of Graduation
12-13-2025
Semester of Graduation
Fall
Degree Name
Doctor of Nursing Practice (DNP)
Department
School of Nursing
First Advisor
Erika Metzler-Sawin
Second Advisor
Monica Cfarku
Third Advisor
Brett Neville
Fourth Advisor
Kelli Van Wagner
Abstract
Background: There are no established staffing benchmarking tools for utilization within comprehensive cancer centers at academic medical centers that account for work occurring outside of the provider visit or that address patient acuity and complexity. The lack of robust benchmarking tools that reflect the work involved in caring for highly complex patients in the ambulatory setting makes advocating for additional staffing needs difficult. The Ambulatory Clinical Acuity Model was created by frontline nurse leaders to provide objective standards on which to factor in the complexities of care occurring in ambulatory oncology clinics.
Purpose: To test the Ambulatory Clinical Acuity Model within a comprehensive cancer center at an academic medical center. Because the Ambulatory Clinical Acuity Model had never been evaluated, a program evaluation methodology was utilized.
Methods: The program evaluation used the PRECEDE - PROCEED model to plan, implement, and evaluate the application of the Ambulatory Clinical Acuity Model within three different oncology clinic teams. The Institute of Medicine’s Six Domains of Quality Healthcare were used to underpin this work. Additionally, the program evaluation incorporated task alignment to evaluate if every clinical team member was working to their full scope of practice.
Results: The Ambulatory Clinical Acuity Model was applied successfully in three unique provider clinics within the oncology clinic. Two out of the three provider clinics’ scores indicated a need for one or two additional staff while the third clinic’s score indicated that they likely have adequate, but not excessive, staff at this time. Task alignment done in all three provider clinics indicated that nursing staff and providers were not working to the full scope of their license.
Conclusion: The findings highlight the importance of assigning an objective scoring system to account for patient, provider, and clinic acuity within comprehensive cancer center clinics within academic medical centers such as the Ambulatory Clinical Acuity Model.
Keywords: ambulatory oncology acuity tool, oncology clinic staffing, outpatient oncology acuity tool, patient acuity tool, oncology patients, cancer patients, acuity-based staffing, oncology acuity tool, patients with cancer
