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Retain top nurses with a clinical ladder

HCPro's Weekly Update on the ANCC Magnet Recognition Program®*, May 9, 2006

One innovative strategy to retain top quality nurses is known as the clinical ladder [writes June Marshall, RN, MS, senior director of clinical practice, research, and professional development, Children's Medical Center Dallas.] Clinical ladders recognize and reward nurses for their clinical development and expertise, while encouraging them to remain involved in direct patient care activities. Several models can be used when creating clinical ladder programs for nurses. One model, described by Patricia Benner, author of From Novice to Expert: Excellence and Power in Clinical Nursing Practice, addresses the stages of clinical, intuitive thinking and clinical decision-making skills that nurses acquire as they grow and develop professionally. Benner's model includes five stages of development:

1. Novice level
2. Advanced beginner
3. Proficient
4. Competent
5. Expert

Benner's work was used as a theoretical framework for our initial clinical ladder at Children's Medical Center Dallas. The current ladder has been revised by our professional development council. Benner's work remains part of the clinical framework for our new Professional Advancement Program, but ours also incorporates leadership elements that assist nurses in their professional development. In our program, nurses interested in climbing the clinical ladder submit portfolios that include clinical exemplars; evidence of professional development in areas such as leadership, education, advocacy, and research; and peer evaluations from colleagues. The candidates then appear before a panel of their peers to complete the promotion process.

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