A Tale of Two Ladders: Creating a Health System Approach to Nursing Professional Development

Learning outcome: After viewing this presentation, the learner will be able to describe the importance of ambulatory care clinical ladders in professional development and how to operationalize a health system clinical ladder.

Purpose: Clinical ladders are proven to have a positive impact on nurse retention, engagement, and certification rates, and they are strongly correlated with an intent to stay. At one large academic medical center, two separate and distinct clinical ladders existed between inpatient and ambulatory care nursing teams. Each ladder had its strengths and weaknesses, and as such, there were some subtle differences between the two programs. Differences included pay practice inequities, rigor imbalance, and uneven availability of options to participants. The two programs were created separately and on different timelines, each growing to be successful over the years. In 2016, a chief nursing executive position was created, thus bringing all of nursing under one leader and initiating a unified health system mindset. Through feedback from existing ladder participants and leaders, a need was identified by the office of nursing excellence to make one unified, system-wide program for the nurse clinical ladder.

Description: In September 2022, a workgroup was launched and spearheaded by the ambulatory care director of nursing professional development. The group comprised inpatient and ambulatory care leaders, nursing excellence, research, direct care staff, NPD practitioners, and nursing executive leadership. The workgroup analyzed program guidelines of other healthcare facility clinical ladders as a basis for best practice. When inspecting these programs for best practices, special considerations were made regarding pay practices and their relation to rigor. Similar options in the ambulatory and inpatient care programs were cross-walked, then adopted or eliminated. The options were combined and weighted according to the effort of the work performed. Weighing options was a new concept for both ladders, which brought respect to work that required more time and rigor than other options. This concept also allows for executives to leverage certain options in the ladder to move the needle on organizational goals, if necessary. With such a large impact initiative that involved staff financials, it was imperative to author a comprehensive communication plan in advance of the go-live. Over the span of six months, details on the new ladder were disseminated across all shared governance councils, staff and leader town halls were provided, and multiple open office hours were offered.

Evaluation/outcome: The unified Health system nurse clinical ladder had its inaugural cohort of packets submitted in September 2023. This was a limited pilot group of 15 successful participants. The newly formed health system clinical ladder committee, comprised of inpatient and ambulatory care advisors, performed their commencing joint packet review day. This streamlined grading process ensures an unbiased, efficient system for determining outcome of level achieved and has shown to increase collaboration between inpatient and ambulatory care team members. Current letter of intent (LOI) submissions for newly biannual packet submissions have exceeded FY23 numbers (142), totaling 175 LOIs FY to date. About another 100 LOIs are still anticipated for the second packet submission window in August 2024.