Moving On Up: Clinical Ladder Programs, are they really worth it? - page 3

Clinical Ladder programs have been used for years to recognize nurses as they progress through levels of nursing practice starting at novice and culminating in an expert level. These ladders are... Read More

  1. by   JKL33
    Quote from klone
    I don't think I've seen such a bunch of Debby Downers all in one place than I have in this thread. I'm seriously flummoxed by the attitudes displayed here.
    In the spirit of "having a cup of coffee" -

    I sincerely believe this is why there is perpetual misunderstanding between staff and administration. I have never felt more perplexed, insulted and just kind of in a state of disbelief, as if the workplace is some sort of alternate reality over the past several years. There have been multiple, multiple reinventions of wheels. You don't understand why people "don't want recognition," but if you really have no dog in this then you understand that part of the problem is that recognition is not the prevailing goal of CL programs. Recognition itself is a means to something else. Recognition (well, genuine appreciation, which IMO is much better than recognition) is not a new thing - - that's what I tried to describe above. CL programs have an inherent problem because their first motive isn't to genuinely appreciate anyone, but rather to use recognition as a means. We used to perceive plenty of genuine appreciation - why would it suprise you to hear that in some places people don't feel great about supplanting genuine appreciation with a "system of recognition?"

    I get the idea that administration is legitimately lacking perspective as far as understanding how various initiatives affect staff. People don't decide to give CLs (or any other initiatives) a sideways glance because the idea came from adminstration, but because of a pattern of manipulation and half-truths and just generally disingenuous treatment.

    We have all kind of accepted the fact that we are going to hear negative things from patients, and that when we do we should listen carefully because within those comments we might notice a pattern or recognize some way that we can improve patient satisfaction or patient care, or even patient outcomes. We will learn how patients perceive our actions. What is flummoxing (great word, by the way!) is that administration will not "hear" and seek to understand what the staff is saying in the same way that we want to listen to what patients are saying. It's quite mind-boggling! So, kindly, I say that it doesn't matter if you think people are Debbie Downers - do you know what I mean? There is a perspective here that is not "all in our heads" and not due to "bad attitudes." Admin keeps telling nurses that we're on the team and asking us to speak up and pretending to empower us to change things for the better. But there is always, always a pre-planned problem and a pre-planned solution to go with it, and the moment anyone even asks a question, it's all over. Anger. Affront. Indignation. Name-calling. Labeling. Doubling down on the same old rotten premise. A "cut off one's nose to spite one's face" situation if there ever was one!

    I don't care nearly as much about recognition as I do genuine appreciation and being afforded dignity. Thanks for hearing me out.
  2. by   klone
    Quote from JKL33
    But there is always, always a pre-planned problem and a pre-planned solution to go with it, and the moment anyone even asks a question, it's all over.
    That may be your reality, but that does not mean that it is a universal truth.

    I've seen intellectual curiosity lead nurses - BEDSIDE nurses - to publish, to lead initiatives, to make policy changes. I see CLs as a way for administration to at least acknowledge the hard work these nurses are doing.

    I still fail to see a downside to it. You don't want to participate? Great! No one's forcing you to do it. But for those nurses who are already doing all those things, at least this is a means to reap tangible reward for it.
  3. by   Tomascz
    Quote from klone
    Wow, what a....interesting way to look at it. Nobody is being coerced into participating in a clinical ladder. Discrimination?

    As a nurse who goes above and beyond, and has more invested in their workplace than just punching a time clock, don't you WANT recognition for your efforts?
    Sure I want recognition, cash preferably, but more importantly I want a hand in ensuring and improving patient care and treatment of nurses which to me go hand in hand. Like somebody else said here, nurses aren't peas in a pod.

    We may be Debby Downers but a.) the response to your proposal should tell you something that you are clearly either not expecting or are unwilling to hear, or possibly b.) the experience of many of those responding here doesn't support what you're outlining.

    Formalized top down systems of evaluation tend to favor the needs of those who build them. I'm betting these are usually a reflection of the bottom line needs of the "business". Do you think that most "for profit" hospitals, or even non profit MBA/bean counter run hospitals, necessarily place a high priority on nurse job satisfaction? I kind of doubt it.

    Do I think compensation needs to be performance based? Sure, but development progresses differently for every individual. It's not a cookie cutter process; and yes, I'm extremely suspicious of management motivations.
  4. by   PeakRN
    Quote from klone
    I don't think I've seen such a bunch of Debby Downers all in one place than I have in this thread. I'm seriously flummoxed by the attitudes displayed here. Until this thread, I have NEVER heard such resounding criticism for the idea of a clinical ladder program. As a bedside nurse, I've participated in the clinical ladder at 4 different facilities. As a member of management at my current facility, I'm assisting the CNO in trying to bring the clinical ladder program to our hospital.

    For those nurses who are fully engaged in the improvement and betterment of their unit and their facility, and are interested in quality improvement and evidence-based practice, do you not WANT to receive recognition for your efforts? I'm trying to understand why providing recognition for a nurse's engagement in her workplace and in improving his/her practice and the unit where s/he works is a BAD thing.

    I mean, for the nurses who are already doing those things, this is a means to provide recognition to those nurses. And for those who aren't doing those things - some of them may be encouraged to do so through such a program. And for those who just have no interest, they don't have to participate.
    Maybe all of the "Debby Downers" are nurses who have had poor experiences with clinical ladder systems (and honestly administration in general), and apparently this is not a problem limited to a small area. This might be a source of some perspective.

    Do you know what I want? I want safe staffing ratios, not sending people home the moment census drops by two patients. I want nurses to be adequately trained and have appropriate resources. I want nursing administration to actually back me up objectively when I have a disagreement with a medical provider. I want administration to actually hire competent staff, not the one with the best looking resume (and this goes for every department). I want to be treated as a person, not a means to an end.

    I don't have experience with every system, but I have been affiliated with quite a few and nurses talk to each other. These problems are not isolated to small pockets or a few cranky nurses.
  5. by   Nalon1 RN/EMT-P
    Quote from klone
    ...

    I still fail to see a downside to it. You don't want to participate? Great! No one's forcing you to do it. But for those nurses who are already doing all those things, at least this is a means to reap tangible reward for it.
    And there is part of the problem. If you don't do A, B, C, D, E, F and G, you get nothing.
    I had everything for the first level where I work, except I do not have my BSN yet.
    Precept new grads, new hires, students. Yup.
    Certifications required, yup.
    Correct number of procedures done and documented. Yup.
    On and on, I have it all, except again, no BSN. So what do I get? Nothing.
    I will be eligible starting January (I graduate in December), but everything I have done so far, well, it does not count.
    I have to start from scratch again. But I need to get it all done before March, because it can only be applied for quarterly when you become eligible, or in June, because that is the deadline for the next budget year. Every year it has to be done. So I would have to do it all. Twice. In 6 months.
    If I miss one thing in the packet, I don't get the money for the entire year.

    It has nothing to do with my actual job performance or patient care. It is a bunch of check boxes and tasks to be done. It is a ladder that every rung you climb up, it gets knocked down every year. Perpetual busy work.

    Are there programs out there that work, maybe, but I have not seen one that makes it all worthwhile and actually makes a difference for me.
    In the end it all comes down to cost, and what staff wants (staffing ratios, competent and appropriate ancillary staff, correct and functional equipment, etc) all cost money.
  6. by   mmc51264
    Well, I am just addressing the tone of your post that nurses that are involved in the clinical ladder process are just doing busy work and can't be great nurses. I work with a lot of great nurses, some are in the ladder program, some not. I just get frustrated with generalizations. I didn't think you were singling me out, but it sounds like you don't have much respect for the nurses that are involved.
    I think everyone should do what they want. I like to be involved and I like it when others are involved to make our work environment better, that's all
  7. by   mmc51264
    We have opportunities 4 times a year to apply to the ladder. I am also finishing my MSN in informatics, so my project is finding ways to filter conditions so we can develop care redesign plans. My focus is using computer language to decrease the time needed to find a certain cohort of patients. The goal is to reduce LOS for specific populations that utilize a substantial multidisciplinary team (surgery, medicine, specialists, OT/PT, pharmacy, endo, etc)
  8. by   JKL33
    Quote from klone
    That may be your reality, but that does not mean that it is a universal truth.


    I've seen intellectual curiosity lead nurses - BEDSIDE nurses - to publish, to lead initiatives, to make policy changes. I see CLs as a way for administration to at least acknowledge the hard work these nurses are doing.


    I still fail to see a downside to it. You don't want to participate? Great! No one's forcing you to do it. But for those nurses who are already doing all those things, at least this is a means to reap tangible reward for it.

    klone -


    I'm glad they make you feel good. I have my reasons for participating. I guess I'll leave it at that.

    Yes, no one's reality is a universal truth with regard to this issue, and yes, no one is literally forcing anyone.
    Last edit by JKL33 on Oct 30
  9. by   bidmc217
    R Wolfe, thank you for this article!
    As an RN employed at the same institution, on the same unit, for almost four full decades, I initially loved the clinical ladder concept. Over time, however, the sole encouragement that I received from my colleagues to advance was purely for the monetary gain. Eventually, it became clear that it was more of a competition for nursing units to attain more "trophies" to sport on the nurse manager's mantle. Today, the more "advanced" nurses are delegated unit responsibilities/chores in an atmosphere of extreme professional discontent. It is this dissatisfaction that has caused a very large portion of our staff to leave our unit and bedside nursing.
    I have been content to remain at my current CN status. I, for one, do not need pay, recognition, nor awards to legitimize my practice. I have always been involved in my unit, contributed to improvements and give expert care to my patients; and they do notice. I feel a profound loss of the Art of Nursing. Though not considered an "expert" based on the Ladder standards, I am indeed an expert whose skills, wisdom and insights, like those of my retiring and discontented Baby Boomer contemporaries, will soon be extinct. A very simple question to consider is, what type of nurse and nursing care would you want for your child, your parent, your spouse, yourself?
    The profession is on a high-speed train of robotics and data collection of ALL types. But data, no matter how "big", moves us further and further away from the individuals entrusted to our care. In fact, we too, as a profession are being pushed further and further away from being viewed by management as individuals [people]. Finances? Balanced budgets have always, always been a concern of medical institutions. No news there! We have become providers of tasks and gatherers of information and specimens, save for those of us who still feel we have a vital role to play. Sadly, the Ladder serves to lead us further and further from our roots.
  10. by   llg
    My opinion:

    They can be done well ... and they can be done badly. Each one has to be judged on its own merits and flaws.

    A common flaw is that people are not clear about what they mean. If they are equated with expertise and excellence, then the standards of expertise and excellence must be clearly articulated. Is advancement a recognition of expert patient care? or of being a good employee? A person can be an expert direct patient care-giver, but a terrible employee -- and another employer can be a great employee, but a terrible patient care provider. etc. etc. etc. And sometimes, environmental conditions change and a clinical ladder program should change in response.

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