Career Ladders

chadash · Sep 17, 2005

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.

This sounds good...

Thunderwolf, MSN, RN · Sep 18, 2005

Also agree with llg...career ladders is a bureaucratic tool that does nothing to improve the quality of care or the retention of good nurses who so happen are left dangling below and unrecognized in this pyramidal structure. Let's not bring back old ideas that have not proven themselves.

Daytonite has a very good idea. The only draw back is the initial or ongoing expense and record keeping of crosstraining, if it should come to that, that Admin might balk at. But, I like the idea.

chimama · Sep 18, 2005

I can see your points about the negative aspect of career ladders. Our feeling as a group was that they could be in place for those who desire the opportunity, but the steps would in no way be mandatory. There are things that I was not aware of until I started looking so I could see where others migh like the guidance as well. We just thought of this as recruitment/retention tool that could be offered to those who were interested. I really appreciate all the comments, you all are voicing some concerns that we had not thought of! Thanks again!

It is naive to think that a career ladder is a recruitment/retention tool.It is a stressor to the staff and a creation of ivory tower nurses who live in the land of NANDA.

brina · Sep 18, 2005

Gosh, I can't believe all of the negative things i've been reading about career ladders! I am not a nurse yet.... I will graduate this December with my BSN, and the Hospital that I want to work for is in the process of incorporating a clinical ladder for their employees. I always thought that this would be a good thing! Isn't the clinical ladder a way to reward nurses financially for education, experience, certifications, etc.?? I always thought it would suck to not be given any kind of differential or credit for these type of things. I know that I have not worked as a nurse yet, so there are bound to be things that I don't know about these career ladders. Can you all explain to me in more detail what the negatives are, and why they outweigh the positives of nurses being rewarded for their achievements? Thanks!

Brina

llg, PhD, RN · Sep 18, 2005

Can you all explain to me in more detail what the negatives are, and why they outweigh the positives of nurses being rewarded for their achievements? Thanks!
Brina

I've already explained one of the major problems in an earlier post ... but here are a couple more. Perhaps other people can elaborate.

1. Advancement up most clinical ladders involve taking on more responsibility and/or performing at a higher level. What happens when a person is promoted up the ladder, receives the pay raise and then no longer performs at that higher level? Sometimes that happens because a person has some health problems, has a baby, or returns to school. Do they then get demoted and have their pay reduced? OUCH! Having to continually monitor everyone's performance to guarantee that they are still deserving of the higher rank (and demoting them when appropriate) is incredibly time consuming for the leadership, burdonsome for the staff -- and most of all, an incredibly painful political process for everyone.

2. Most employers give cost-of-living raises that are a percentage of a person's base salary (e.g. 2% per year). Each year, a person gets a raise of a certain percentage to compensate for the rising cost of living. If your base salary is higher, your raise is more. For example, if your salary is $80,000, a 2% raise gives you and extra $1600. If you make $40,000 per year, 2% raise gives you an extra $800. Now ... imagine what happens over a period of many years as that process is repeated every year. The person who started out making more money "pulls away" further and further from the other person.

With a clinical ladder, the person who gets promoted early in their career not only gets the bonus associated with the ladder program, but often also gets the higher cost-of-living raises. Over years that adds up to a significant amount -- EVEN IF the person is demoted back to the lower level because of poor performance. The ladder bonus is taken away, but the cost of living bonus remains. That leads to compensation differences that linger indefinitely that can cause feelings of unfairness within the staff.

That has happened at the hospital where I currently work. They used to have a pay-for-performance system. Now we have nurses with the same level of experience who get paid different amounts because 10 years ago, one of them got a higher raise than the other. Now, some of the former stars performer are not stars -- but they still makes significantly more money because becasue of the mathematical effects of those former raises - 10-20 years ago. Again, that causes anger among the current staff.

3. Sometimes, nurses who have not received a promotion up the ladder will resent those who have. "Why should I take on that extra responsibility. Let xxxx do it. After all, she's the level 3 nurse. She's making extra money to do those things." A unit needs ALL of its nurses to be willing to pitch in and do the work that needs to be done. Creating a sub-group of "favored" nurses can disrupt the teamwork.

4. Who determines the criteria for promotion -- and makes the decisions about demotion? It can become (or at least be seen as) an exercise in who is the boss's favorite. Who has "sucked up" the best?

5. Sometimes the work of documenting practice in order to justify the promotion (or demotion) becomes cumbersome and time-consuming. Staff and management spend so much time trying to do a good and fair job of selecting the recipients of the promotions, that it takes away from the time and energy they have to do the other work that needs to be done.

I've encountered all of these problems in real life during my 28-year career, most of which has been spent in CNS and/or staff development roles. Because of these problems, I am not keen on complex clinical ladders. I favor straight-forward pay scales based on years of experience with bonuses/differentials added for certain easily measured/documented things -- such as precepting, charge nurse, mentor, committee participation, etc. Such a system rewards the people who etcdeserve to be rewarded, but keeps the politics to a minimum. As people contribute more, they get paid a little more ... but as they contribute less, their differentials/bonuses become less.

llg

shodobe · Sep 18, 2005

I agree with all of the negative comments. Our "career ladder" system was a good idea at the beggining but soon became a total waste of time for all. The stress was immense because it wasn't hard to achieve the criteria but having to do it to maintain your level was a joke. I am a level 3 and the problem is we have to do the same thing year after year to maintain our level and there should be some kind of maintenance requirements after you have achieved this level. There was an article written several years ago in the AORN mag about Baylor Uni program that a person a wide variety of options on how to achieve and maintain their career ladder level without the mundane task of repetition. I personally feel ladders are a waste of time and an adminstration's way of frustrating their nursing staff. They hope nurses will not participate or will drop out, thus giving back their 5% hike. There is no "merit" raises where I work and everyone has to rely on career ladders for an increase in pay. We do have a union and our scale is somewhat based on this contract, but I have never asked what my rate would be if I suddenly siad I didn't want to participate in career ladders. Believe me, I would be ecstatic if I didn't have to worry about career ladders evey year. Notice I said "worry", because it isn't a priviledge to participate but a need because without it there wouldn't be any reward for your good work during the year. If you need to start one do me a favor and make the initial requirements a certain number but after that person achieves that the maintenance should not be the same year after year.

Forgot to add if you want a copy of our carrer ladder requirements just PM me and give me a fax number and I will rush it out to you. Mike

suzieqrnc · Feb 8, 2008

Hi Mike,

I am on a committee to construct a clinical ladder for our nurses. I would very much like to see yours. We are still in the writing phase, but need more direction. Also if you could clue me in on how your facility "pays" the staff for climbing the ladder. That is, is it a lump sum bonus or hourly wage increase? Also the amounts would be great! I don't have a fax at home, but if you could send it to my work that would be great! Please make sure a sheet with my name on it comes through first, as no one will know who it belongs to! Thank you so much, Sue Schiman 417-269-6494

I agree with all of the negative comments. Our "career ladder" system was a good idea at the beggining but soon became a total waste of time for all. The stress was immense because it wasn't hard to achieve the criteria but having to do it to maintain your level was a joke. I am a level 3 and the problem is we have to do the same thing year after year to maintain our level and there should be some kind of maintenance requirements after you have achieved this level. There was an article written several years ago in the AORN mag about Baylor Uni program that a person a wide variety of options on how to achieve and maintain their career ladder level without the mundane task of repetition. I personally feel ladders are a waste of time and an adminstration's way of frustrating their nursing staff. They hope nurses will not participate or will drop out, thus giving back their 5% hike. There is no "merit" raises where I work and everyone has to rely on career ladders for an increase in pay. We do have a union and our scale is somewhat based on this contract, but I have never asked what my rate would be if I suddenly siad I didn't want to participate in career ladders. Believe me, I would be ecstatic if I didn't have to worry about career ladders evey year. Notice I said "worry", because it isn't a priviledge to participate but a need because without it there wouldn't be any reward for your good work during the year. If you need to start one do me a favor and make the initial requirements a certain number but after that person achieves that the maintenance should not be the same year after year.
Forgot to add if you want a copy of our carrer ladder requirements just PM me and give me a fax number and I will rush it out to you. Mike