Revision of a Clinical Ladder: A Journey to Professionalism

Sunday, November 1, 2009: 4:35 PM

Valorie A. Dearmon, MSN
Adult Health Department, USA University College of Nursing, Mobile, AL

Learning Objective 1: identify the processes required to transform an existing clinical ladder program into a professional advancement tool which promotes professionalism and nurses use of best evidence.

Learning Objective 2: describe strategies to facilitate success and to promote staff engangement in a complex system change.

With increased demands for quality and safety in healthcare, organizations are calling on registered nurses to join the commitment for better patient outcomes.  Creating a professional environment that engages registered nurses’ support of organizational goals for quality and promotes nurse satisfaction has been accomplished by hospitals implementing a well built clinical ladder program.  The American Nurses Association’s Credentialing Center (ANCC) identifies the importance of professional development as a force of magnetism and recognizes a clinical ladder program as one tool to promote growth and development.  Research is beginning to indicate that nurses ascending to higher levels on ladders demonstrate greater confidence, better standardize practice based on evidence, and perceive care rendered as better in quality.  Due to a lack of relevance in today’s complex healthcare environment, the revision of an existing clinical ladder program used by two sister hospitals was completed.  The revision included a plan to fully integrate the ladder into the performance evaluation system.  The revised ladder, modeled after the University of Colorado’s clinical advancement program, utilizes as a framework Benner’s Novice to Expert Model and the American Nurses Association’s Scope and Standards of Nursing Practice.  The process to lead the change initiative, promote staff ownership of the revision, incorporate the use of best evidence, and achieve consensus among stakeholders, is included in the discussion of the project.  Celebrated accomplishments and lessons learned of the change initiative are highlighted.