Document Type

DNP Project

Department

School of Nursing

Date of Degree

Spring 2026

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Karen J. Whitt, PhD, APRN, FNP-C, AGN-BC, FAANP

Keywords

Nursing Workforce; Workforce Challenges; Nursing Retention; Structured Telework Models

Abstract

Background: Ambulatory nurse retention remains a critical workforce challenge amid national nursing shortages and escalating demands for care delivery efficiency. Limited schedule flexibility contributes to job dissatisfaction and turnover, despite a substantial proportion of ambulatory nursing responsibilities being suitable for remote completion. While telecommuting has demonstrated workforce benefits in other sectors, structured telework models in ambulatory nursing practice remain under-evaluated. Rigorous evaluation of innovative, scalable staffing strategies is essential to strengthening workforce stability and sustaining quality patient outcomes.

Purpose: This quality improvement project evaluated the impact of a structured telecommuting staffing model on ambulatory nurses’ job satisfaction, intent to stay, perceptions of organizational support, productivity, delegation of tasks, and quality of care.

Methods: A three-month pre–post quality improvement design was implemented across eight ambulatory clinics within a metropolitan Magnet-designated children’s hospital. Eligible non-union ambulatory registered nurses participated in a telecommuting option of one to two days per week. Workforce and operational outcomes were measured using a 25-item survey adapted from validated instruments. Descriptive statistics were used to compare baseline and post- implementation outcomes.

Results: Telework participation reached 100% of eligible nurses, exceeding the predefined 50% implementation target. Intent to stay increased from 69% at baseline to 80% post-implementation. Job satisfaction and perceptions of organizational support demonstrated positive descriptive trends. Productivity, delegation of tasks, and quality of care were maintained or improved following implementation. Participants reported favorable integration of telework into ambulatory practice.

Conclusions: A structured telecommuting staffing model was associated with improved nurse retention indicators without compromising perceived productivity or quality.

Implications: Findings support telecommuting as an evidence-informed, scalable workforce innovation with implications for ambulatory staffing policy, organizational sustainability, and future implementation research.

Open Access

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Available for download on Friday, April 28, 2028

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