The project’s purpose was to create an effective ambulatory care nursing clinical ladder program to promote nurse engagement, leadership, professional growth, and retention. A nurse’s work engagement is positively associated with job satisfaction and their perceived quality of care and negatively associated with their intent to leave a position. Within this academic institution, an inpatient clinical ladder program was well established; however, ambulatory care nursing lacked a clinical ladder program.
Nurses participating in shared leadership recognized the need for a clinical ladder program highlighting the unique specialty of ambulatory care nursing. Essential stakeholders including nursing practice, education, leadership, and human resources developed the program. The group utilized six essential steps for development: inpatient program framework alignment, measurable program criteria, recognition system establishment, peer support network creation, and the addressing of program sustainability.
The inpatient clinical ladder program framework was reviewed to assess for alignment opportunities and applicability within the ambulatory care setting. Benner’s (1982) novice to expert theory and the AAACN Scope and Standards were utilized to establish a rubric with measurable criteria for each ladder step (advanced and expert). The criteria included certification, specialty expertise, leadership, research involvement, community engagement, and a clinical exemplar.
The group partnered with human resources to create incentives and recognition plans within shared leadership forums. Program sustainability was also addressed with continuous program evaluation including bimonthly steering committee meetings. The committee comprised of ambulatory care leaders and nursing professional development specialists routinely reviews the need for updates to the program and modifications to its criteria. Lastly, a peer support network was established through the creation of a clinical ladder champion role.
Outcomes: The clinical ladder program showcases substantial engagement among nurses, with 52 promotions (32 advanced and 21 expert) across 28 departments. Activity involvement included quality improvement initiatives (n=41,80%), task force/committee work (n= 33, 64%), educational materials development and led in-services (n= 32, 62%), shared leadership involvement (n= 22, 43%), policies and procedures development (n= XX, 41%), and community engagement (n=14, 27%). Nurses involved in the clinical ladder have a retention rate of 96%. Additionally, 12 nurses were clinical ladder champions assisting prospective applicants.
Implications for practice: The utilization of a clinical ladder for ambulatory care nurses enhances retention, job satisfaction, and engagement locally, regionally, and internationally. By developing a structured pathway for professional advancement, nurses feel encouraged to pursue continuous learning, skill development, and foster a sense of value within the organization.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.