Moving On Up: Clinical Ladder Programs, are they really worth it?

Richard Wolfe, RN

Clinical Ladder programs have been used for years to recognize nurses as they progress through levels of nursing practice starting at novice and culminating in an expert level. These ladders are often based on the five levels presented in Patricia Benner's Novice to Expert Theory. Here is a brief refresher of the five levels of Benner's Theory:

Novice Nurse

A new nurse or a nurse with no experience in the field they are entering. Both the new graduate and the nurse transitioning to a new field of practice (for example- Med-Surg to Oncology) would be considered a Novice. The Novice learns rules and applies those rules universally to all patients.

Advanced Beginner Nurse

The Advanced Beginner Nurse has gained practical experience and has learned how to conditionally apply the rules on a patient by patient basis in future clinical situations.

Competent Nurse

The competent nurse has become more efficient and organized having learned from prior experiences. This nurse is starting to see how their clinical actions impact long-term goals.

Proficient Nurse

The Proficient Nurse views their patient holistically and has learned through significant practice how to distinguish between significant aspects of the clinical picture and those that are not as significant.

Expert Nurse

The Expert Nurse relies on intuition gained from years of experience and can hone in on key aspects of the clinical picture in order to achieve the best outcome for the patient.

If your facility offers a Clinical Ladder Program, then you may wonder if it is worth the time and trouble to complete the requirements. I hope to help you to reach a decision by offering a brief look at a few of the pros and cons to climbing the Clinical Ladder.

PROS

Money

Most people can use more money and a bonus offered by a Clinical Ladder Program is certainly a nice incentive. Some programs offer one time bonuses while others offer an increase in pay.

Recognition

Achieving and maintaining a level on the Clinical Ladder is a way to both recognize your achievements and to distinguish yourself from others at your facility.

Networking

Working your way through the Clinical Ladder process provides the opportunity to interact with those you may not have routine contact with. Examples include those in administration, leadership, education, and peers practicing in different clinical areas within your facility.

Professional Development

If the money, recognition, and networking aspects of the Clinical Ladder are not important to you, then there is always the value of professional development. Participating in the Clinical Ladder program may very well lead to growth in your profession. One example would be a nurse of 20 years that never saw the importance of obtaining National Certification. Participation in the Clinical Ladder program may motivate the nurse to obtain certification to move up the Clinical Ladder.

CONS

Time and Effort

The Clinical Ladder program requires a significant amount of time and effort that may not pay off in the end. A 5% increase in pay offered as an incentive could be accomplished with a lot less headache by simply working a little bit of overtime. If you work 40 hours per week, then that would mean an additional 2 hours per week or one extra 8-hour shift per month. Add the overtime and possible incentives for working that extra shift and you are already ahead of the game.

Politics

Unfortunately, politics still plays a significant role in the nursing profession. Opportunities that allow an individual to advance up the Clinical Ladder may not be offered to nurses in an equitable manner.

Lack of Opportunity

For example, you may be able to acquire points for achievements such as being a preceptor, learning new skills, or cross-training to other areas. However, there may not be money in the budget to cross-train or learn new skills. In addition, if there are no new employees on your unit, then your chances of being a preceptor are pretty much non-existent.

Upfront Expenses

You may be required to pay out of your own pocket to achieve skills such as National Certification. If your organization only offers reimbursement upon successful attainment of the certification, then you will initially pay hundreds of dollars up front and then wait until you pass to get reimbursed.

The Rules Can Change

It can be extremely frustrating to put forth the time, effort, and possibly money into completing the Clinical Ladder Program only to find out later that the requirements have been changed. An example would be volunteering at the local blood drive for 8 hours each month thinking that it would count toward the community involvement requirement. Then right before you turn in your completed packet, the organization addends the requirements so that your participation at the local blood drive is no longer accepted toward that requirement.

It Can Disappear

Organizations are not obligated to continue the program. All of your time and effort are for naught if your organization pulls the plug on the clinical ladder.

What do you think? Are Clinical Ladder programs worth the effort or would you rather spend your time doing something else? Share your thoughts in the comments section and take the poll to let others know your opinion.