CLINICAL LADDER FOR A COMMUNITY HOSPITAL

According to a 2013 hospital employee engagement survey at a southwestern medical center, nurses indicated that they had limited opportunities for professional growth and career advancement. In addition, they perceived that their hard work and effort were not recognized. These perceptions led to high nurse turnover rate, a disengaged work force, and decline in patient care quality, substantiated by data provided by the Human Resource and Performance Improvement Departments. If these negative trends were to continue, they might result in substantial decreases in reimbursement and increases in expenditures due to high nurse turnover rates. An exhaustive review of the literature on clinical ladders was conducted. Based on strong evidence, a Clinical Ladder Program (CLP) provides a means to recognize and reward nurses’ expertise in clinical practice and keep them at bedside. A CLP can potentially improve retention and job satisfaction, and enhance professional development and patient care quality. The purpose of this project was to develop a CLP for a community hospital. Benner’s “Novice to Expert” was selected as the theoretical framework for the proposed CLP. A CLP with four clinical nurse levels was developed. The CLP plan included the ladder itself, a detailed description of each clinical nurse level, including clinical skills, job description, performance standard, educational requirements, and application and credentialing processes. During development of the CLP, an overall campaign to increase awareness about the possibilities of a CLP was begun. Discussions unearthed perceived and local barriers and facilitators associated with adoption and implementation iv of the CLP. These included the need for administrative support and monetary incentives for nurses who perceived that the CLP required large investments of time and energy due to the need for pursuing further nursing education. The CLP implementation plan addressed these in a realistic timeline that is dependent upon the adequate financial stability of the hospital (due to projected costs associated with raising salaries for nurses at the higher levels of the ladder). Potential outcomes measures and evaluations associated with CLP were postulated to give hospital administrators a complete overview of the project scope before implementation; these include enhanced nurse retention and job satisfaction (with subsequent lower turnover rates), increased educational levels of the staff (necessary in a Magnet environment, which the hospital is discussing), and improved clinical outcomes such as decreased errors and better safety outcomes. Lessons and perspectives gained during this project are as follows: identification of potential barriers to a CLP such as the strongly held perception of experienced nurses about the recognition that experience and education have differential effects on nursing skills; the necessity of the hospital’s being able to afford a CLP; and overall limited awareness of staff and key stakeholders about CLPs. Thus, the planned implementation and evaluation take into account empiric evidence as well as local needs.