Clinical ladder change

[Mini2544]

Hi everyone!
I am just curious if anyone else’s hospital adopted this same policy, as far as our clinical ladder in nursing is concerned. Currently we have a Nurse 1,2,3,4 etc. In order to progress to the next “rung” per se you have to meet certain criteria. I think the highest may be a 5 but you need x number years experience plus a masters, certification etc. Most RNs are 2 and 3s. Previously in order to become a RN 3, you needed 1 year experience plus a BSN OR a certification (PCCN, CCRN etc) Well my hospital decided that going forward, in order to stay an RN 3 (which has a higher pay than 1 and 2) you need BSN AND certification. They are giving those who don’t have the certification 6 months to get it or else they will be dropped to RN 2 and take a pay cut. We are currently working on becoming a magnet hospital but I’m not sure that plays a major role it in. It absolutely seems like a horrible thing to do your more seasoned staff after the Covid situation. Thoughts?

[JKL33]

3 minutes ago, llg said:

There is no raise in pay -- just a one-time bonus that is paid out when your application is approved. Then the next year, you can apply again if you meet the criteria.

That is reasonable. For the upcoming year each would-be applicant has the opportunity to decide whether the proposed bonus is line with the requested/required displays of excellence.

I would consider that fundamentally different than publishing the terms of a ladder, declaring what people must achieve, having them achieve it and then changing the terms.

11 minutes ago, llg said:

I suspect this has only a little bit to do with Magnet and more to do with the hospital trying to save money by having not so many people staying at the higher level.

It makes sense that the reasonable method you describe would be useful for maybe saving money by not having so many people stay at the higher level. I doubt a place would risk it while trying to achieve magnet status, though, for the very same reason - - as many people may not do it.

Therefore I would guess that their abrupt decision to renege on their terms is directly related to their magnet pursuits.

[Mini2544, ASN, RN]

19 hours ago, llg said:

When my hospital established its clinical ladder a few years ago, several nurses had experiences from other hospitals that influenced the design of our program. They designed it so that you have to "apply fresh" each year. There is no raise in pay -- just a one-time bonus that is paid out when your application is approved. Then the next year, you can apply again if you meet the criteria. That makes it easier to deal with people who were excelling one year, but not maintaining that level of excellence year after year after year. It also makes it easier to change the criteria from one year to the next for the bonuses. They haven't made significant changes over the last few years, but they could.

I suspect this has only a little bit to do with Magnet and more to do with the hospital trying to save money by having not so many people staying at the higher level.

I actually think that’s a great idea! I also tend to agree with your last statement as well. They are still doing merit raises this year so I kind of think they already assumed some people would move down so if they do.. it prob won’t be much of a pay rate decrease. It def could be worse. This change doesn’t affect me very much but some others are upset about it

[Mini2544, ASN, RN]

On 8/17/2020 at 12:20 AM, Sour Lemon said:

I can see how that’s unpleasant, but it could be worse. Twice, I’ve seen the entire LPN staff fired because a hospital changed their requirements for working in acute care. Some had been at their jobs for 30+ years. I suppose they could do the same thing with ASN nurses if they wanted to.

23 hours ago, JKL33 said:

I would be opposed to this on principle. An agreement was already made and something has already been achieved. Those who achieved RN 3 pay grade should remain subject to the rules in place at the time they achieved it. Also, even if people are not to be exempted in this way 6 months is a short time frame, so this is a double-whammy.

It is a wrong thing to do irrespective of covid.

I would do what apparently a lot of people are doing: Meet their demands if they happen to be in line with my personal goals. Then proceed with personal goals (which will not involve a continued relationship with people who behave this way).

I agree with all you said. 6 months is a short time frame! I think a year would be more appropriate

[amoLucia]

I'm guessing that there's NO union to be speaking up.

[Mini2544, ASN, RN]

16 minutes ago, amoLucia said:

I'm guessing that there's NO union to be speaking up.

Unfortunately not. Union politics aside... I really wish we had a strong presence of one in Florida.

[mmc51264, BSN, MSN, RN]

Ours has changed a little too.

New nurses start as a CNI, after their first year and the new grad residency, they are a CNII (experienced nurses that are hired, start as a CNII)

In order to move up to a CNIII, we need to have a BSN and certification (I am ortho, so that certification works for me). We are also required to write up an example of how we have impacted a patient in a positive way.

The highest level is a CNIV. It requires the same as a CNIII, but there is a list of things that we can choose from to add to our "portfolio" For example, a poster presentation, a masters degree, etc. The final requirement is an outcomes project. I have done two data collections and an intervention, but keep getting results that are not statistically significant.

To maintain each status, we have to keep our certification and work on a committee or in a couple of different areas (clinical practice counsel, unit expert is one of several areas, etc). Plus more CEUs with each rung.

There is a 5% raise with the CNIII and CNIV (I can't remember if I got a specific raise for the CNII).

I have found that there is less encouragement to climb the ladder now, compared to a few years ago. It could be related to the manager we had. It used to be that to be a clinical team lead for the unit, one had to have your CNIV but now a III is enough. We do not have very many CNIVs. I am going to keep trying. I have my certification and my MSN. I am the unit champion for EPIC and diabetes. I just need to get a good project!

[Nurse SMS, MSN, RN]

Its pretty common. Since the level of 2, 3, 4 etc have to be earned on an annual basis, they aren't being "dropped" to a lower level and there is no breach of contract. The level criteria changed and they have to earn it for the year, just like before. The extra pay was a bonus, not base pay. That distinction is hugely important. If they chose to see it as base pay, that was a mistake. It was bonus pay based on reaching the criteria set. It's not wrong to up the criteria. There has not been a change in job description. Just in bonus criteria.

Most places don't do it as hourly pay anymore. These days it is more common to have a one time payout per year. They were told in enough time to meet the new certification criteria before next year, so while its probably not their favorite, its not unfair.

[DowntheRiver]

On 8/18/2020 at 5:59 PM, Mini2544 said:

Unfortunately not. Union politics aside... I really wish we had a strong presence of one in Florida.

What part of FL? I'm curious if my former facility is doing this. I heard rumors.

[Mini2544, ASN, RN]

1 hour ago, DowntheRiver said:

What part of FL? I'm curious if my former facility is doing this. I heard rumors.

If your facility is a trauma 1 center in Disney world.. than it’s prob the same place LOL

[9kidsmomRN]

To achieve magnet one requirement was to have 80% BSN by 2020. Our hospital was not going to achieve that- we are rural and only have an ADN program locally, so for that and other reasons, declined to resubmit for our 4th (we were magnet 3 consecutive times) Magnet.

[BSN-to-MSN, ADN, BSN, RN]

We had this system 2 years ago, now it has been changed to every level of advancement needs an involvement in quality improvement project. For level 4, a nurse needs to "publish" the QIP, level 3 - lead QIP, level 2 - participate in QIP. Points only count if QIP is in the works. I don't play this anymore.

And yeah, absolutely, the BSN and push to get a certificate has to do with the Magnet.

I do what I want professionally, on my own timeline, and do not play their game anymore. I am level one.

[CKPM2RN, ASN, EMT-P]

On 8/21/2020 at 7:40 AM, RN-to- BSN said:

I do what I want professionally, on my own timeline, and do not play their game anymore. I am level one.

Thank you. Not everyone wants to play the game, some of us want to clock in, treat all of our patients to the best of our ability using the latest data and practices, then clock out. This is my second career and I started at 50. I am not spending the money or the time jumping through too many hoops but at my age and experience I don't play games thrown down by capricious employers.

Of course I read articles, I follow the latest science, I'm not an idiot. I just have no interest in being part of the machine of hospital drama, which is how I see a lot of it after my 30+ year career prior.