Career Ladders

LPNs can be placed in supervisory positions over CNAs or in education positions in nursing education. LPNs can also serve as preceptors for other LPNs and CNAs. They should also have opportunities to serve as members or unit representatives to certain hospital committees.

I am so happy to read that I am not the only one who doesn't like career ladders! Over the course of my 28 year career, I have worked for 2 hospitals with career ladder systems -- and both were a mess and the source of lots of problems, always needing adustments to keep the staff from open rebellion against them.

As I am in a leadership position, I am often involved in discussions about whether or not my current employer should develop such a system. As one of the few "naysayers," I often feel a lonely. Most of my colleagues have never worked in a hospital with a career ladder and have only the literature to go by. Of course, no one publishes articles about the problems with their programs: people only write about their successes. It makes programs look a lot better than they actually are.

llg

One of the big problems in both hospitals that had clinical ladders where I worked is that everyone soon learned how to meet the critieria to be promoted to the next level. Let's face it, nurses aren't stupid. We soon learn how to work any system to our favor. Well ... the hospital didnt want to promote everyone. That would be the same as simply giving everyone big raises and was considered too expensive. It also would undermine the whole idea of having a system where some nurses would be at higher levels than others. So ... nurses were pitted against each other in their competition to get one of the coveted higher level positions on the career ladder. That was bad for morale and teamwork.

It also caused big problems on units with low turnover. The people who had gotten promoted to higher levels on the ladder stayed there forever -- making it impossible for the newer staff to have a chance at those positions.

So the hospital had few choices:

1. Let everyone be promoted up the ladder -- which was too expensive and went against the idea of having some people at higher levels than others

2. Continually adding more criteria (hoops to jump through) in order to be promoted up the ladder -- which was both cumbersome and unpopular

3. Have the system in place -- but have it be pretty useless because the senior people in the higher positions never left and the younger people had no chance of moving up the ladder

None of those choices was a good choice.

llg

For years I've had what I thought was a kind of unique idea that would probably fit this discussion. I think that staff nurses should have the opportunity to experience some of the duties of the supervisor or manager and that a program could be set up and designed to rotate RNs through these jobs. I think that this idea could be expanded and adapted to fit into a recruitment/retention program. I worked on a stepdown unit for 5 years. Anyone who's worked one knows how stressful and chaotic they are. In fact, most units have pretty high stress levels. I could count on my fingers that times we were overstaffed by one RN. A couple of times when that happened we made the extra RN the IV nurse for our shift, our unit. We all wanted it. Why? You weren't responsible for the 8 hour management of a group of patients. All you had to do was make sure the IV antibiotics got hung, new IV bags put up, and restart IV's that needed it. It was kind of a breather from doing primary care. And, of course, you could pitch in and help the others when your IV duties were done. I think that one of the best rewards you can give a staff nurse is a day (or shift) not having to do patient care. So, what kind of jobs outside of staff nursing can an RN (or even and LPN) do? I think there are a couple of supervisory functions that can be broken down and given over to staff nurses. Staffing is one of them. Trying to round up a couple of nurses to fill holes in a schedule isn't particularly hard, but you're sitting down making phone calls instead of being on your feet. Bed control within the critical care group of units is another. IV team nurse (if there is an IV team) is another one. I think that the clinical round function of the supervisor could also be handed over to an RN. If these tasks could be designed for staff nurses to spend a couple of shifts doing, I think there would be a lot more satisfaction among the staff. They would look forward to not having to take a patient assignment and they would be going to several nursing units. Seeing the other nursing units outside the one you work on day after day is an exciting experience. You see things done a little differently and you get some ideas to help work out problems on your own unit. You also get to meet and talk with nurses outside your own unit. When I became a supervisor I realized that I was engaging in nursing activities that rounded out my view of how the hospital works. I've always felt that every RN should have the opportunity to walk in the supervisor's shoes--it's one of the most interesting jobs I had and it's partly because there are so many different things a supervisor has to do. So, for retention purposes, a day as a supervisor, as a staff coordinator, or an IV team nurse should be considered.

Another job for an RN would be what I called the Ultimate Preceptor. This is a nurse who would make rounds on new orientees, new grads or just about anybody who needed help with new procedures, questions of prioritizing, or just to collaborate on a problem. Got an NG tube you're having trouble getting in, call this person. This is actually also a supervision function, but an experienced staff nurse could fulfill it very easily.

I hope those ideas came across clearly. I can visualize them in my mind so easily, but writing them down is harder.

:yeahthat:

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