Anyone worked with a clinical ladder? Problems?

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Specializes in multispecialty ICU, SICU including CV.

Where I work, we have a clinical ladder -- it's not really called that, but that's what it is. Nurses are paid and placed into categories based on their work performance, which gets evaluated once a year by the NM. There are 4 levels for staff nurses and then management/leadership positions and nurse execs are beyond the 4 levels.

Has anyone run into problems with nurses being pushed into roles too soon in order to move up the clinical ladder? Where I work, management tries hard to put nurses into positions so they can climb the ladder, which means they need to both precept, have some committee involvement and be in charge to get to the highest level. This is great because nurses get their raises and promotions sooner, BUT it often means that the least experienced nurses are in leadership roles. We routinely have nurses with 1-2 years of experience orienting new staff when there are expert clinicians (30+ years) on the shift. Charge responsibilities get rotated to everyone with about a year of experience under their belt even though it is unlikely that they are the best resource on the unit and may still be struggling to master some clinical scenarios themselves, not to mention they haven't developed much in the way of leadership skills. Committee work -- well, nobody likes committee work, new or old staff, it seems.

Any thoughts?

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Not really. I don't even do the clinical ladder...ours is set up so that if you don't have a BSN, it is impossible to get enough points to get the minimum bonus. When we complain about it, the response we get is "Well, it was set up by a committee of your nursing peers..." Thanks for nothing.

On the other hand, when someone asks me to do something and tries this carrot of "this will help you in your clinical ladder." My standard response is, "Since I'm an associates prepared nurse, it's impossible for me to get enough points for the clinical ladder. Thanks, but no thanks. Offer the position to one of your bachelors prepared nurses who actually qualifies for it."

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I worked in a facility just instituting a clinical ladder a few months before I moved, and what I remember, was that you needed a certain # years experience for each level, as well as the committees, certifications, degrees, etc. So it was something like you needed at least 3 years experience to move to level 2, 5 (or 7, I can't remember) to move to level 3, and like 8 (or 10) for level 4. That time limitation helped those green nurses gain experience before being pushed into precepting and charge roles.

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Specializes in pulm/cardiology pcu, surgical onc.

Our clinical ladder is something you have to apply for. You cannot get past the 3rd step without a BSN. After you create your portfolio full of exemplars, committee contributions, and other bs it goes to a clinical ladder committee to be judged if you are worthy of clinical ladder and an increase in pay on top of the union wage scale. Once you start this you also have to continue this with a new portfolio every 2 years to be able to Keep that $1 extra an hour. No thank you.

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My experience with the clinical ladder is positive overall. I oriented to charge at about 6 months and have consistently received positive feedback from peers and my NM.

I started having students follow me almost immediately on beginning my career. (One if you want to know it teach it and two it keeps m honest as a professional.) I had worked in my area as a non nurse for 25 years before assuming my role as an RN.

As a nurse in a federal position I see the influence of the military on our promotional system. I submit feedback to my NM and she uses that to prepare my performance review which is submitted to the board for review. (Boarding is one of those military influences.) We are evaluated across 4 dimensions and need to provide exemplars for review by the board.

I work on a committee just for the purpose of getting exposed to other perspectives and to also work on making things better. (Auditing charts is a great way to have a chance to think about quality of care issues.)

My point of view is that if you don't try and expose yourself to the chance to make mistakes that proficiency will take that much longer to develop.

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Specializes in multispecialty ICU, SICU including CV.
My experience with the clinical ladder is positive overall. I oriented to charge at about 6 months and have consistently received positive feedback from peers and my NM.

I started having students follow me almost immediately on beginning my career. (One if you want to know it teach it and two it keeps m honest as a professional.) I had worked in my area as a non nurse for 25 years before assuming my role as an RN.

As a nurse in a federal position I see the influence of the military on our promotional system. I submit feedback to my NM and she uses that to prepare my performance review which is submitted to the board for review. (Boarding is one of those military influences.) We are evaluated across 4 dimensions and need to provide exemplars for review by the board.

I work on a committee just for the purpose of getting exposed to other perspectives and to also work on making things better. (Auditing charts is a great way to have a chance to think about quality of care issues.)

My point of view is that if you don't try and expose yourself to the chance to make mistakes that proficiency will take that much longer to develop.

Viking, I think this is an interesting perspective because (I think you know this) -- we work at the same facility under the very same ladder. I can see how it would work in some areas from your post and not others. I work in a very high-tech, critical care area with a steep learning curve and I think it takes quite a bit longer to get up to speed as a clinician than it does in psych (although I am sure psych nursing has it's challenges.) Orienting to charge at 6 months or a year I do not think works for us for those with no work experience or no ICU experience. At that point, most inexperienced staff are still barely feeling comfortable. Pushing them into precepting and charge to get their nurse II does not seem to be benefiting the new nurses that we hire in (getting a preceptor that barely knows what they are doing themselves) or the unit (it does not run smoothly when a newer nurse that can barely get out of their own room has to manage staffing and transfers and any other issues that come up.) Thank you for your post.

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ITA. I would not have oriented to charge at 6 months if I had started on m/s as a new grad. I had the MH experience base to support assuming the role.

Because so many VA nurses are military/ex-military I think the training system tends to be oriented towards signing staff off using army style checkoffs. This results in a "must know" orientation for training and proficiency. In like it as it spells out what I need to do to move forward in my career.

One good thing about the board system is that we are not evaluated by our direct service line chief. Our considerations go before a committee to consider our merits.

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Specializes in floor to ICU.

I have done the clinical ladder for the past two yrs. To get to level III at my facility you need an additional certification. Frustrating because I have enough points but no other cert (yet). The hospital is talking about getting grant money for nurses to obtain an additional cert. in the future. That would be nice.

My clinical ladder pay amounts to an extra $1200/yr for level II without much effort. I don't think about how that breaks down hourly...THAT is depressing. lol :D

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Specializes in Critical Care.

The young ones advance the clinical ladder because they see dollar signs; the older ones no it's a big scam so aren't in a hurry to join the herd. I don't think its worth the time, energy and stress of all the busy work to get and then keep the one time raise. Our facility has a demotion clause in the agreement, basically you jump thru all these hoops for a one-time tiny raise which they then hold over your head for evermore. They give you a raise but reserve the right to demote you and take it away! If that's not the most disrespectful thing I've ever heard of. Only in nursing would you get a raise with the threat of a demotion in the same sentence. The smart ones refuse to climb the ladder when they are being treated with such blatent disrespect. They want you to be certified and join nursing organizations but with your own money of course, their so cheap they even refuse to reimburse you!

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Specializes in Adult Critical Care/Neonatal ICU.

We can go from a Clinical Nurse II to a III or a IV. Each step is worth 5% in pay. It sounds like the work that goes into our clinical ladder for a 10% raise is worth much more than some of you that get a $1 raise. I wouldn't bother with all of the extra work if it wasn't worth 10%.

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I was told that if I didn't "agree" to promote myself to RN II that I would be fired. I had to write an essay, CV, letter of intent, print out transcripts, orientation checklists, most recent review and get a recommendation from one of my preceptors and then put it in a binder and all on my own time. A few years ago, in order to go from RN I to RN II, you just needed to be in your position for a year. I had just had a baby and was asking to work less when I was tasked with submitting my "portfolio". I was tempted to see if they would actually fire me because I was so burned out by that point but I decided I needed my job more....I think this "clinical ladder" thing is just a sophisticated form of the old school hazing nurses used to be notorious for.

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