Clinical Ladders: Are they useful?

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    This is my first post. Have been lurking for a while and have learned a lot. I think it's called: "Misery loves company". Have had many the same problems at work(hospital)as you are all having. Wish I had a solution other than more nurses to carry the load.
    We have been looking at using Clinical Ladders to advance bedside nurses who do not want to go into management. Would like some input. Pros and Cons.
    I did pick up on Brownies(Brownms46) post under the topic"Could this be the Cause of the Nursing Shortage?" Here's her quote:
    "I feel that clinical ladders would be the best way to go. Many people understand career development levels, as you have associate managers, assist. managers etc. Why not the same thing in nursing? Make the techincal level the start of nursing, and then allow those who want to continue on, the advantage of having a income, while they pursue advancement."
    CaronRN58
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    Hi CaronRN58. I've participated in discussions about clinical ladders on this bb.

    My experience with the clinical ladder system has been somewhat disappointing in that it was more political then objective. I felt the basis for it was a good idea, however. When ladders are being discussed, it is imperative that there be input from bedside nurses.

    Many employers are flattening their layers of management. Bedside nurses and frontline managers and supervisors are being increasingly expected to take on more of the responsibility in addressing administrative and patient care issues. Higher levels of management are justified at our expense.

    Some of the questions I have about clinical ladders is:

    1. If patient care is tiered, for instance, as nurse I, II, and III, then at what level would APNs (advanced practice nurses)fall or should there be a fourth level for APNs?
    2. If a nurse wanted to go into management, what educational background would be required assuming that bedside nursing practice is considered a rung below management?
    3. Should bedside nurses be required to increasingly give concern and attention to unit business as they move up the direct care ladder?
    4. Should there be a dual clinical ladder program in which bedside nursing and management are viewed equally?

    I think a clinical ladder program can be helpful to address some of the turf problems that exist between nurses with different educational backgrounds, skills, and experiences. It can only work if done, as I pointed out earlier, skillfully and in an objective way.

    [This message has been edited by Mijourney (edited April 01, 2001).]
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    I believe your interest in clinical ladders is an answer to many problems in nursing but management often feels it is too expensive. I worked in a Clinical Advancement Program (CAP) for 10 years. There were 4 levels for clinical with clear job descriptions and performance standards written by bedside nurses. The 4th level was for the clinical specialist The management levels (3) were written by managers. There was a salary increase attached to each level. Education was an important factor in the CN IV level, requiring a masters degree, the other levels were based on experience, and other performance standards. CNIII's were usually certified in their speciality. It was a wonderful program and excellant for moral. It went by the wayside with a merger. The new management found it more econimal to group everyone together with just longevity being a factor. Morale and patient care suffered. It is a hugh undertaking too develop a clinical ladder but well worth the effort. I see the merged hospital moving back in that direction. Your question was excellant.

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