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

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    Clinical Ladders are used by many institutions to recognize nurses as they progress from a novice level to that of expert. This article offers some pros and cons of participating in a clinical ladder program.

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

    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 often based on the five levels presented in Patricia Benner's Novice to Expert Theory. Here is a brief refresher of the five levels of Benner's Theory:

    Novice Nurse- A new nurse or a nurse with no experience in the field they are entering. Both the new graduate and the nurse transitioning to a new field of practice (for example- Med-Surg to Oncology) would be considered a Novice. The Novice learns rules and applies those rules universally to all patients.

    Advanced Beginner Nurse- The Advanced Beginner Nurse has gained practical experience and has learned how to conditionally apply the rules on a patient by patient basis in future clinical situations.

    Competent Nurse- The competent nurse has become more efficient and organized having learned from prior experiences. This nurse is starting to see how their clinical actions impact long-term goals.

    Proficient Nurse- The Proficient Nurse views their patient holistically and has learned through significant practice how to distinguish between significant aspects of the clinical picture and those that are not as significant.

    Expert Nurse- The Expert Nurse relies on intuition gained from years of experience and can hone in on key aspects of the clinical picture in order to achieve the best outcome for the patient.

    If your facility offers a Clinical Ladder Program, then you may wonder if it is worth the time and trouble to complete the requirements. I hope to help you to reach a decision by offering a brief look at a few of the pros and cons to climbing the Clinical Ladder.

    PROS

    Money- Most people can use more money and a bonus offered by a Clinical Ladder Program is certainly a nice incentive. Some programs offer one time bonuses while others offer an increase in pay.

    Recognition- Achieving and maintaining a level on the Clinical Ladder is a way to both recognize your achievements and to distinguish yourself from others at your facility.

    Networking- Working your way through the Clinical Ladder process provides the opportunity to interact with those you may not have routine contact with. Examples include those in administration, leadership, education, and peers practicing in different clinical areas within your facility.

    Professional Development-If the money, recognition, and networking aspects of the Clinical Ladder are not important to you, then there is always the value of professional development. Participating in the Clinical Ladder program may very well lead to growth in your profession. One example would be a nurse of 20 years that never saw the importance of obtaining National Certification. Participation in the Clinical Ladder program may motivate the nurse to obtain certification to move up the Clinical Ladder.

    CONS

    Time and Effort- The Clinical Ladder program requires a significant amount of time and effort that may not pay off in the end. A 5% increase in pay offered as an incentive could be accomplished with a lot less headache by simply working a little bit of overtime. If you work 40 hours per week, then that would mean an additional 2 hours per week or one extra 8-hour shift per month. Add the overtime and possible incentives for working that extra shift and you are already ahead of the game.

    Politics- Unfortunately, politics still plays a significant role in the nursing profession. Opportunities that allow an individual to advance up the Clinical Ladder may not be offered to nurses in an equitable manner.

    Lack of Opportunity- For example, you may be able to acquire points for achievements such as being a preceptor, learning new skills, or cross-training to other areas. However, there may not be money in the budget to cross-train or learn new skills. In addition, if there are no new employees on your unit, then your chances of being a preceptor are pretty much non-existent.

    Upfront Expenses- You may be required to pay out of your own pocket to achieve skills such as National Certification. If your organization only offers reimbursement upon successful attainment of the certification, then you will initially pay hundreds of dollars up front and then wait until you pass to get reimbursed.

    The Rules Can Change- It can be extremely frustrating to put forth the time, effort, and possibly money into completing the Clinical Ladder Program only to find out later that the requirements have been changed. An example would be volunteering at the local blood drive for 8 hours each month thinking that it would count toward the community involvement requirement. Then right before you turn in your completed packet, the organization addends the requirements so that your participation at the local blood drive is no longer accepted toward that requirement.

    It Can Disappear- Organizations are not obligated to continue the program. All of your time and effort are for naught if your organization pulls the plug on the clinical ladder.

    What do you think? Are Clinical Ladder programs worth the effort or would you rather spend your time doing something else? Share your thoughts in the comments section and take the poll to let others know your opinion.
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  2. Poll: What is your opinion of Clinical Ladder Programs?

    • I love it. I am currently an active participant.

      16.13% 5
    • I do it for the money.

      19.35% 6
    • I dislike them. I am not an active participant.

      16.13% 5
    • Not offered at my facility, but I would participate if it was available.

      6.45% 2
    • I have more important things to do with my time.

      48.39% 15
    31 Votes / Multiple Choice

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    35 Comments

  4. by   klone
    I'm a fan of anything that promotes and encourages frontline nurses to engage in research and QI activities.
  5. by   KatieMI
    It took me quite a bit of energy to make it absolutely clear that I was not, and never will be, interested in anything any close to politics, meetings, policies and schmolicies. Clinical /technical question? I am always here. Research a problem?
    Sure, any time. Educate/explain things? With my preasure. Otherwise, get off my neck.
  6. by   JKL33
    Quote from klone
    I'm a fan of anything that promotes and encourages frontline nurses to engage in research and QI activities.
    I can agree with the spirit of that statement.

    I also believe in a sort of corresponding reverse, which is that nurses who perform non-direct patient care functions which include collaborating and/or making decisions about things that affect patient care, should be encouraged, as part of any evaulation of their performance, to log hours in a regular assignment, in scrubs, on a regular basis - "regular" meaning however often they would need to do that in order to maintain competency with such. This includes Nursing Infomatics, RN Patient Relations personnel, RN QI staff, Risk Management, all levels of Nursing Management, etc.

    Consider it a Gemba Walk if that sounds better.
  7. by   klone
    I agree with that, but that's kind of outside the scope of what the OP is asking, which is about clinical ladders for (presumably) bedside nurses. Some of the best research and QI can be done right at the bedside, on subjects that are wholly pertinent to bedside nursing care.
  8. by   mmc51264
    I love being part of the clinical ladder program. I am certified in my specialty, am our unit expert on diabetes and spend a lot of time advocating for our diabetic patients (especially the type 1s that barely anyone knows anything about). I am a preceptor, I teach in out core specialty class to prepare new nurses who, I think, are getting cheated in their orientation. It is not that much extra work and I feel that it is important to be invested in my unit. We have too many nurses that are not involved and complain. Be part of the awareness and solution instead of complaining. I am getting ready to complete my level 4, which is the highest our ladder goes. There is always something that can be done better/smarter and I am all about that.
    I realize it is not for everyone, but I do feel that everyone should have some involvement at the unit level. Just coming to work, do your 3 12s and leave is not helping morale.
  9. by   JKL33
    Quote from klone
    I agree with that, but that's kind of outside the scope of what the OP is asking, which is about clinical ladders for (presumably) bedside nurses. Some of the best research and QI can be done right at the bedside, on subjects that are wholly pertinent to bedside nursing care.
    I agree.

    My other thought applies the instant we start talking about "things that are good for [bedside] nurses," though.
  10. by   klone
    I agree with you - it's worthy of its own thread, since it's not really germane to this conversation, as clinical ladders aren't typically available or relevant to non-clinical nurses.
  11. by   Nurse Beth
    It's hard to measure clinical competence or excellence by many of these activities.

    I've seen nurses who are not "expert" achieve Clinical Nurse III by doing the busy work required.

    Thinking there has to be a better way.
  12. by   klone
    Quote from Nurse Beth
    It's hard to measure clinical competence or excellence by many of these activities.

    I've seen nurses who are not "expert" achieve Clinical Nurse III by doing the busy work required.

    Thinking there has to be a better way.
    Not all clinical ladders are created equal. I've seen some where you were REQUIRED to have a specialty certification as part of it. Others where you had to have equal activities in one of several areas including mentorship, clinical expertise, CEUs, policy development, formal education, research, etc.

    They don't HAVE to be just busywork. It all depends on how they're developed.
  13. by   PeakRN
    Rarely do great nurses advance through clinical ladder programs, from my experience it has been those who do busy work and have the right connections to have their portfolios approved. I feel that it is also just a way to pinch pennies rather than given nurses who are working hard for their unit the raise that they deserve.
  14. by   klone
    Quote from PeakRN
    Rarely do great nurses advance through clinical ladder programs, from my experience it has been those who do busy work and have the right connections to have their portfolios approved. I feel that it is also just a way to pinch pennies rather than given nurses who are working hard for their unit the raise that they deserve.
    Every facility I've ever worked for that had a clinical ladder offered the increase in pay through the clinical ladder IN ADDITION TO their regular annual performance raise, not instead of.
  15. by   PeakRN
    Quote from klone
    Every facility I've ever worked for that had a clinical ladder offered the increase in pay through the clinical ladder IN ADDITION TO their regular annual performance raise, not instead of.
    Where did the money for the clinical ladder come from? Could that have been used for cost of living and merit raises if there was no clinical ladder? Could the raises at your hospital have been more substantial as a result?

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