Clinical Ladders

Nursing staff turnover is a costly issue that hospitals and medical centers will continue to deal with as the nursing shortage progresses (Shader et al, 2001).

It is imperative hospitals have the ability to attract and retain new hires.  It is of equal importance that hospitals reward and recognize current staff for their expertise and involvement in professional activities.  Hospitals offering clinical or professional ladders have higher levels of satisfaction among nursing staff than hospitals with no method for career advancement (Drenkard & Swartwout, 2005).

Sentara RMH Medical Center supports an environment that promotes professionalism and excellence in nursing care.

The following are some areas of clinical practice and professional excellence that are recognized in this clinical ladder program:

  • Professional Nursing Service
  • Clinical Nursing Competence
  • Leadership Skills
  • Continuing Education
  • Evidence Based Practice in Nursing
  • Nursing Career Plans
  • Volunteer Nursing/Health Service outside of hospital
  • Customer Service and Hospital Wide Initiatives for Excellence
  • National Certification in nursing specialty area

Objectives

  • Promote, Recognize, & Reward excellence in clinical practice and professionalism of Sentara RMH nursing staff
  • Promote exceptional bedside nursing patient care and clinical performance by participation in the areas of leadership, continuing education and through evidence based practice participation
  • Provide clear delineation of nursing competence levels
  • Utilize nurses who have been educationally prepared for a variety of levels of practice
  • Encourage excellence in practice to ensure quality care of patients.
  • Champion recruitment and retention of qualified registered nurses
  • Commitment to customer service and Sentara RMH excellence standards
  • Promote participation in volunteer community and health nursing service

Automatic Advancement Levels I and II:

  • Clinical Nurse I (Novice) – Clinical Ladder entry level for a new graduate RN or RNs with less than one year of recent experience. After successful completion of department orientation, a nurse will automatically advance to a Clinical Nurse I.

    • Description – A new bedside registered nurse developing nursing skills, expanding knowledge, and assuming job responsibilities.

  • Clinical Nurse II (Advanced Beginner) – After receiving first satisfactory Annual Evaluation, a direct clinical patient care registered nurse will automatically advance to Clinical Nurse II level. A newly hired, experienced registered nurse (with at least one year of recent nursing experience) will be placed at a Clinical Nurse II level.  After successful completion of department orientation and after first successful PACE evaluation, an applicant may advance to higher clinical ladder levels by following all program requirements. All RNs will remain at Clinical Nurse II level if they do not choose to advance to higher levels.

    • Description - An experienced direct clinical patient care registered nurse who provides independent patient care and is actively developing more advanced nursing skills and knowledge through education and involvement in nursing activities beyond basic job requirements and responsibilities.

Personal Performance Advancement Levels III, IV and V (Voluntary Participation):

  • Clinical Nurse III (Advanced) – Requires annual portfolio submission and compliance with all clinical ladder program requirements.  Advancement to this level requires self-paced and self-motivated participation.

    • Description – A direct clinical patient care registered nurse highly skilled in patient care; provides leadership and mentorship abilities; has active involvement in continuing education and in nursing activities beyond the basic job requirements and responsibilities.

  • Clinical Nurse IV (Proficient)Requires annual portfolio submission and compliance with all clinical ladder program requirements.  Advancement to this level requires highly self-paced and self-motivated participation, and a BSN degree.  A COPY OF YOUR BSN MUST BE INCLUDED FOR VALIDATION.

    • RNs who are currently at the Clinical Nurse Level IV and do not currently hold their BSN will be “grandfathered in” for 2017, remaining at their current level (assuming all other requirements are met).  An applicant at a level less than IV may not advance to the Level IV without getting their BSN.
    • Description – A direct clinical patient care registered nurse who has a broad base of advanced nursing experience; recognized for professional nursing leadership and knowledge; leadership extends to education and development of others; involvement in multiple nursing activities beyond basic job requirements and responsibilities; acquiring research skills by participating in evaluation of clinical outcomes to improve nursing through evidence-based  practice. 

  • Clinical Nurse V (Expert)Requires annual portfolio submission and compliance with all clinical ladder program requirements.  Advancement to this highest level on the clinical ladders requires extraordinary and exceptional self-paced and self-motivated participation.  Applicant must have a BSN degree and be nationally certified in their current nursing specialty.  A COPY OF YOUR BSN MUST BE INCLUDED FOR VALIDATION.

    • RNs who are currently at the Clinical Nurse Level V and do not currently hold their BSN will be “grandfathered in” for 2017, remaining at their current level (assuming all other requirements are met).  An applicant at a level less than V may not advance to the Level V without getting their BSN (national certification in a specialty has already been a part of the program).
    • Description – A direct clinical patient care registered nurse who has exceptional advanced nursing experience; recognized for expert professional nursing leadership and knowledge; leadership is recognized at a role model level; involvement in multiple nursing activities beyond the basic job requirements and responsibilities; developing professional involvement in improving nursing through evidenced-based practice, such as research activities, journal clubs, writing a published nursing article, etc.  

All Evidence-based Practice submissions must follow SRMH Institutional Review Board Policy and Procedures and research materials must be presented in a professional format with extensive information, such as charts, graphs, studies, stats, outcomes, etc.

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