Does the Clinical Ladder violate Labor Laws?

meandragonbrett · Jan 18, 2012

I don't even know what to say to this. :confused:

elkpark · Jan 18, 2012

I don't, either.

I don't know much about the labor law precedents described by the OP, but I do know that hospitals pay a lot of money to have very good legal counsel, especially the kind of large, urban, academic medical centers that first developed the "clinical ladder" models, and I doubt that "clinical ladder" programs would be so widespread among healthcare organizations if they could be challenged in court and cost the hospitals settlements.

ASCO2260 · Jan 18, 2012

Valerius, you raise a very good point, I hope somebody answers because our hospital just started

a similar program. Thanks.

Snowmelt · Jan 18, 2012

While it may appear the clin 2 and clin 3 are doing the same job, they are not. the clin 3, theoretically, is doing the job better and safer due to their education. Studies repeatedly demonstrate the higher the base level of education of the RN, the lower the OE (observed over expected mortality rate). Additionally, most clin 3s have to do some sort of extra educational project/research to be elevated to that position. The internal skill set of the clin 3 is greater than the clin 2's per what and how your institution values, rewards, and recognizes said interal and external skill sets. They are bringing different internal skill sets to the same outward actions. Make sense? Hope so.

Griffd · Jan 18, 2012

Does anybody have any expert information regarding Clinical Ladders in violation of labor laws? Or examples of cases (related to clinical ladders) challenged in the court of law for violating labor laws?
I have read and studied a lot to understand the Synergy Model of Nursing theory and it's application in the nursing profession. Now, I want to go a step further; Is it the best and fair way for an institution to recognize and compensate for the performance of the nurse, or to encourage the nurse to pursue a higher degree of education?
As an example, my institution is not able to, nor can it show that a clinical ll or a clinical lll have different expectations when working side by side within a 12 hour shift. Nor do they have different job descriptions. However, the clinical lll nurse is being financially compensated (8% more) for doing exactly the same job as everybody else. I know that the 'Equal pay Act was passed into law to deal with salary inequalities between men and women, but it has been used in court arguments similar to this, and the Equal pay Act doesn't even require 2 employees to have exactly the same job descriptions to be compensated equally, the language in the law says 'similar job descriptions'.
I know that clinical lll and lV nurses are required to participate in committees, etc, etc, etc.....but, they are paid for that extra time they put into these "extra curricular activities", and in a 12 hour shift, when two nurses report to work, one is being paid more when both are expected to provide the same care. Clinical lll or lV nurses are never expected to be the first ones to take extra patients when short staffed, or to take the most challenging assignments, or to do CVVHD, or to precept a new employee. The charge nurse making the shift assignment is more inclined to give the 600 lb patient to the young male nurse because can lift more than the 62 year old female nurse; however, he can not claim or demand extra payment because they have the same job descriptions and both are expected to perform the same tasks.
There is also such a thing encoded in labor laws as discrimination based on education....there is a famous McDonald's case where an employee with a college degree was being paid more than a high school kid when both had exactly the same job descriptions of flipping burgers side by side. The court ruled in favor of the high school kid. The state is the organ that grants nursing licenses, not making distinctions between the diploma, associate, or baccalaureate degrees.....then, the hospital creates these artificial classes of nurses that don't exist.
What are your thoughts on this? I'm particularly interested in hearing about the legality part of the all argument.

Responses to your question on Labor Unions: The reason why ost Union do not recognize clinical ladders is that they are based on seniority and most members are aged with AD degrees verses the New Generation Xer who are educated with BSN and Masters Degree and most of them have not done bedside nursing yet. As a male nurse I can relate to your concerns about someone hiring me over a female because of my ability to lift more; however, that in itself is discriminating towards me and yes it is true I am asked daily to help co-workers who cannot move the 300 plus patient. In addition, your bargaining unit would be much better off with closed units and clinical ladders. Institutions with clinical ladders have stagnant nurses with no vertical mobility Your HR deaprtmetn dictates Job Descpritions not the union, so I would start with HR. However, the union may have a flat rate of pay for all levels of RN and if that is the case it is what it is.

Griffd · Jan 18, 2012

Responses to your question on Labor Unions: The reason why ost Union do not recognize clinical ladders is that they are based on seniority and most members are aged with AD degrees verses the New Generation Xer who are educated with BSN and Masters Degree and most of them have not done bedside nursing yet. As a male nurse I can relate to your concerns about someone hiring me over a female because of my ability to lift more; however, that in itself is discriminating towards me and yes it is true I am asked daily to help co-workers who cannot move the 300 plus patient. In addition, your bargaining unit would be much better off with closed units and clinical ladders. Institutions with clinical ladders have stagnant nurses with no vertical mobility Your HR deaprtmetn dictates Job Descpritions not the union, so I would start with HR. However, the union may have a flat rate of pay for all levels of RN and if that is the case it is what it is.

tntrn, ASN, RN · Jan 18, 2012

I have wondered about this for thirty years or more, long before Clinical Ladders were even invented.

If anybody can prove to me that an experienced (20 years or more) ADN RN is doing a inferior job compared to a BSN with any experience of less than, oh, say, five years, I'd like to see it.

I don't think patient care suffers one tiny little bit. I think the two different nurses may "think" about certain problems differently, but in the end, they are both (probably and hopefully) going to do the right thing, and probably in the same or similar way.

Not that I am against people getting or having a BSN; but having along side nurses who are ADN, ASN, BSN and even MSN, you just can't tell who has what by their patient care.

Griffd · Jan 18, 2012

I am not referring to patient care issues. I know a lot of LPNs who do beside nursing better than RN but without education they cannot get paid like a RN. Most unions will not allow clinical ladders because they feel everyone is equal; therefore, creating nurses without a future.

Esme12, ASN, BSN, RN · Jan 18, 2012

While I agree with turn, if the hospital chooses to pay the BSN more for their extra college.....as long as it is clearly stated what the requirements are......strangely enough they are legal. As long as the "levels" are clearly laid out and everyone has "equal" opportunity to fulfill those requirements.........they are perfectly legal. My personal belief is that they pigeon hole excellent nurses and their potential as well as experience therefore negating their value and what they bring to the patient....something that can be measured in patient outcomes, a decrease in errors, as well as early intervention in crisis situation by recognition and intervention that only comes from experience. But they are completely legal.

Without seeing the ladder requirements themselves it is difficult to be sure, so if you are questioning their legality take the policy requirements to a lawyer and let them look at them. Being assigned the 600 lb patient because you are male can be described as assigning patients towards clinical expertise and ability to deliver that patient quality care, even though your superior strength (in most cases) is the determining factor........the point can be made that you can give that patient superior care over a 80lb female nurse. Just like assigning the pregnant nurse from radiation or high risk infectious is not discriminating against the nurse but providing a safe work environment to the employee....which is required by law.

Merit systems are very subjective and are prone for the " favorites" to get the better raises. Unions advocate across the board raises to maintain equality with hourly compensation for degrees to "keep everything equal", but promote paying even the under performers the same as exemplar employees. Clinical ladders depending on how they are set up place the experienced nurse as less value than the "BSN" nurse even though they are exemplar employees and clinical experts.

Concluding the system is hopelessly flawed.....

I am usually able to provide sources or references but with the different media blackouts today I am finding I am unable to today....

gonzo1, ASN, RN · Jan 18, 2012

At work sometimes my fellow nurses make fun of me because I am always going to classes and nursing seminars etc. Usually get about 50 CEUs a year. Just cause I dig it. The other day one of the nurses proudly stated that she had not been to even one such thing in the last 12 years. (This will change because the state is now requiring it.)

I do think that I should be paid a little more because I am taking the initiative to increase my education. As it happens the place I work at does not recognize this and everyone is paid based on years of service.

I could go elsewhere, but I love where I work so I stay. By the way, the no class nurse is a very good nurse and I do respect her skills.

But in the long run I may end up taking better care of my patients because of the extra hours I spend improving my nursing knowledge and skills.

Or maybe not, maybe no amount of extra education will make me smarter. Maybe I am just a dummie. I know I sure as heck don't want the government telling my job what to pay me.

If you don't think you are being paid appropriately then you need to go look for a different job.

Griffd · Jan 18, 2012

Education and skills are liken to ones teeth...ignore them and they will go away. Every nurse should strive to be a better nurse and through CEU programs and college courses are paramount in being a good nurse