The Clinical Ladder

[BeachsideRN, ASN]

Forgive me if this is a 'stupid' question. But what exactly does this mean? I am a new nursing student. I see this phrase repeatedly on this forum, but never with an explanation of exactly what the clinical ladder is/entails?

My background is chemistry (ba), toxicology (ms) and public health (mph) and I am now going back to get my BSN. After working in academic research for 10 years, I have a desire to be involved on the clinical level. My focus has always been hem/onc and I really want to move into Peds Hem/Onc, BMT/HSCT, type work. In fact, St Jude is one of my "Mecca" places to work (ever since I was in grade school).

I guess my question is .... What is the best way to pursue this dream and climb that proverbial ladder?

[classicdame, MSN, EdD]

Each facility defines this, assuming they even have the program in the facility. It is a means by which nurses can accrue a larger base pay by accomplishing steps on the "ladder". Steps can be another nursing degree, certifications, community volunteer hours, training other nurses, precepting students - whatever the facility defines as meeting the criteria. You get paid more for accomplishing more.

[BeachsideRN, ASN]

Gotcha. Thank you for clarifying!

[klone, MSN, RN]

Also, many facilities differentiate their RN staff based on whether they're on the ladder. At many facilities an RNI is a new grad who is still in orientation. RNII is a regular nurse. RNIII is someone who's on the clinical ladder (usually the "first rung" - has a BSN, maybe a specialty certification, precepts other nurses or students, etc), and an RNIV is someone higher up on the clinical ladder - certifications, advanced degree, possibly even published. I've never seen any places that go beyond IV.

Places that have a clinical ladder usually offer $1-2 more per hour for being on the ladder. You have to keep a pretty extensive portfolio, go in front of a committee, and it has to be re-done annually. At some facilities it's WAY more work than it's worth, at other facilities it's fairly easy and straightforward.

[classicdame, MSN, EdD]

we dropped it because people would not keep up with their portfolio then whined when their pay was cut. It got to be a retention bonus more than clinical ladder. We do merit raises only now, no bonuses. We also allow per diem for working nights, weekends and critical care. Our scheduling is electronic and tied to HR database, so if critical care nurse allows required certs to expire the per diem is eliminated and/or they get suspended. So people are managing their certs better. Amazing what incentive $ will do.

[applewhitern, BSN, RN]

I have worked at quite a few hospitals in my career, and I can say I have never worked at a hospital that has a "clinical ladder." I think our local VA facilities have it, but none of the hospitals I worked at did. An RN is an RN is an RN at all the hospitals I worked. One of them paid 25 or 50 cents more per hour for a BSN.