Clinical Ladder for LTC

[kwvath]

I am a former ICU nurse working as an ADON/Unit Manager at a SNF. When I worked at the hospital we had a clinical ladder program (RN I, RN II, etc.) that encouraged personal growth, employee retention, and increased job satisfaction.

In all my searching, I have only found Clinical Ladder examples for acute care/hospital settings. However, I can only imagine what a huge impact this type of program could have on skilled nursing facilities.

Does anyone have any good examples of a Clinical Ladder model for long-term-care settings? Ideas? Comments? Suggestions?

[noc4senuf]

I have never seen or heard of one for LTC.

[Moogie]

I think this is an interesting concept, but based on my experiences in LTC, I don't think it would work well. The work environments in which I have experience did not encourage excellence or recognize expertise, particularly among CNAs. I have worked with amazing CNAs who have had wonderful, practical knowledge of how to handle people with severe dementia and some of the behaviors associated with dementia but, instead of being recognized for their knowledge, the other CNAs thought they were being "know-it-alls" and the nurses resented them because they could not accept that maybe a "mere" CNA knew more about a matter in patient care than they did.

To be frank, my experiences in LTC have been such that excellence and expertise among NURSES is not recognized. I know of one nurse manager who was an ineffectual jerk who had no idea how to manage people and was threatened by so much as a legitimate suggestion from her staff that their approaches might be better than hers. I also know of an abusive and nearly psychotic manager who "ran the show" with her beer buddies and was more concerned with partying than with making sure the nurses felt supported and professionally strengthened.

I loved the residents in LTC and felt strongly that my presence was an attempt to ensure that they were getting high-quality, holistic care, but I could not take the lack of professionalism. Maybe it's different in other facilities but I am not taking that chance with my career.

ETA: Besides, administration would never go for a clinical ladder as it might mean higher employee costs as staff ascended such a ladder. At one facility, the only criterion for getting a merit raise was attendance at all the damned staff meetings. Ridiculous.

[SuesquatchRN, BSN, RN]

It really is all about the money.

And I am sometimes astonished at the lack of professionalism I see. Ystdy I was in my teeny office, which is a desk shoved into a space near the employees' toilet, and turned off my hearing aid because on days that TPTB are not in the floor nurses can become SO raucous that it's disturbing. And I'm finally in the exalted status of "they don't hate my guts," so there's not much I am willing to do. Yet.

We can't fire people, either. No bodies to replace them so major ineptitude is accepted.

[nyteshade, BSN]

Doesn't happen in SNFs...and for many reasons:

1. It really is all about the $. I work MDS, and yes I can tell you it really is.

2. SNFs don't like forking over money for just anything, especially for something most already feel is your job.

3. It's not large like a hospital with many depts, and resources.

It would be interesting to see one though...nothing is impossible...