Clinical Ladder Program Analysis

Each staff member should display a high echelon of outstanding care due to their impressionable experience levels and infinite amount of training. The majority of them will have advanced credentials in specialty areas. The nurses and other staff members emphasize family and patient education to increase the possibility of independence.

Current trends in healthcare are leading to more complex, advanced patient care and needs. Hospitals and patient services are now in need of highly skilled, trained, and educated professionals to deliver this care. The impact of these trends extend into the profession of nursing, where employers are taking a closer look at the outcomes of patient care delivered by ADN graduates vs. BSN prepared nurses. Although

Patricia Benner, a well-known nursing theorist who published From Novice to Expert, theorizes how a nurse should progress through their career. Benner’s theory explains what stage of nursing one is in based on your education and the amount of time one has worked in a specific nursing field. She describes the five stages of the theory: novice, advanced beginner, competent, proficient, and expert. While this theory has its limitations, it is beneficial to the well-being of both the nurse and patient and that is proven by real world clinical practice.

Healthcare systems and the way safe, quality health care is delivered are continually changing to better serve patients and communities. Professional nursing practice is a large component in the healthcare system today. Back in the 1960s, professional nursing leaders tried to adopt the bachelor degree programs as the only educational track to become a registered nurse (Creasia & Friberg, 2011). Due to nursing shortages and demands this motive did not hold fast. Individuals entering the nursing profession today must first decide which educational pathway to take to become a Registered Nurse (RN).

Transitioning from nursing school to working in a hospital setting can be a challenging time for a new graduate. Due to the nursing shortage, new graduate nurses are being hired with little to no experience. This is overwhelming for new nurses, especially when they are not getting adequate support or training from the hospital. The amount of stress, pressure, and lack of training is leading to a high turnover rate for new graduate nurses. With patient acuity on the rise, new graduate nurses that are filling these vacancies in the hospitals, need to be competent nurses to provide proper and safe care to the patients.

With an ever-increasing body of knowledge in the field of nursing, more education is being required to enter the field of nursing. Many healthcare institutions are raising the educational requirements in order to become employed or maintain employment in their facilities. Healthcare organizations are transitioning to hiring registered nurses (RN) who have a higher level of education, such as, a graduate from a Baccalaureate Degree Nursing (BSN) program. The goal of these institutions is to have nurses with a broader array of skills that can meet the growing demands of our patient population. BSN prepared nurses are recognized for their well-rounded skills in critical thinking, management, case management and health promotion versus Associate Degree nurses (ADN)/Diploma nurses that focus on direct patient care.

staff, the skill level of the nursing staff, and the education/certification of nursing staff” (ANA, 2015). These

Clinical ladders have been used in nursing to provide opportunities of advancement in the health care field. “The clinical ladder program is integral to the institution’s recruitment and retention efforts, professional advancement, and evidence-based practice initiatives” (Pierson, Liggett, & Moore, 2010, p. 39). Facilities that incorporate clinical ladders are great for nurses that want to push themselves and become a leader over time. The following design is my interpretation of a clinical ladder. The differences between each of the three levels of nurses are the focus on increased independent practice, expanding knowledge, and expected responsibilities.

Across the United States, hospitals are experiencing a nursing shortage. Yet, according to the American Association of Colleges of Nursing, 63,857 students graduated from nursing school in 2015 alone and enrollment is increasing. It seems like a lot of new nurses to fill those vacancies, does it not? Studies show, however, that within a year, about thirty percent of those new graduates have voluntarily left their job (Hillman). Further studies have attributed the high turnover rate to new nurses’ lack of competency to handle conflict, make critical decisions, and function autonomously (Bratt). Many of the new graduates are disappointed with the hospital’s orientation, or lack thereof. Lack of knowledgeable preceptors and lack of nursing staffing in general has led to new nurses being thrown into autonomous function more quickly. Without proper training, these nurses must make sound clinical judgements and provide competent care to patients, which anyone can imagine is stressful. Today, Nurse Residency Programs (NRPs) are being instituted in numerous hospitals as a way to improve new graduate nursing skill, but research shows many other benefits to these programs. NRPs also reduce hospital spending costs, increase patient safety, and most importantly increase new nurse retention rates.

Some of the dilemmas associated with today’s nursing force are: Many are under-educated and task-oriented, unaware of their patient’s plan of care, medical histories, or pertinent results. Too many rely on clinical coordinators and team leaders, when it comes to critical thinking, therefore, miss out on the vital fundamentals, which make nursing such an honorable profession (Grietens, 2007, p. 10). In order to create a stronger, more knowledgeable nursing workforce, entry-level requirements for RNs, as well as APRNs, need to be uniform. In addition, research shows bachelors and masters prepared nurses, result in better patient outcomes. An example of a proposed solution includes:

Bedside competencies need to be measured not only by educational degree, but also by level of experience and the particular environment in which the nurse practices. For example, in a large university level teaching hospital, both the ADN and the BSN prepared nurses have access to clinical nurse specialists, clinical nurse educators, on site social workers, case managers and chaplaincy services. Nurses in this environment also have access to Journal Clubs, in-services taught by multi-disciplinary teams and participate in research studies concerning their patient populations.

Nurses working for Magnet hospitals are encouraged to increase their professional knowledge. Nurses are encouraged to grow as a clinician by participating in clinical ladder programs, obtaining certifications, and pursuing advanced degrees. Magnet status is a designation for hospitals that wish to provide excellent patient care and promote nursing leadership. Many hospitals offer tuition reimbursement to encourage nurses to continue their education to pursue an advanced degree. Clinical ladders offer professional and monetary gains. A local Magnet hospital in Richmond, Virginia offers reimbursement for the cost of certification exams to help their nurses have an opportunity for certification in their specialty. McClure explains that magnet hospitals develop a culture of excellence by demonstrating best practices and involving nurses in decision making and policy development. There is a correlation between the nurse with a higher level of education and certifications in their area of expertise and positive patient outcomes. (McClure, 2005).

The first goal is to "promote professional development through mentoring programs for career development, professional growth, increase of morale, and quality within my nursing career by the end of one year." The second goal is to "apply the principles of effective organization involving use of information, focus on patient care giving, and design clinical care giving in an organizational chart to achieve organizational planning and evaluation as all levels."

Recent research has shown that hospitals and health care organizations that employ a higher number of bachelors prepared nurses see better patient outcomes as a result of the nurse having a greater capacity to practice (Impact of Education, n.d.). Studies have shown that bachelors prepared nurses practice more confidently and as a result can react faster to patient situations resulting in better outcomes (Impact of Education, n.d.). Also a bachelor’s prepared nurse is trained more extensively in “clinical, scientific, decision making, and humanistic skills, including preparation in community health, patient education, and nursing management and leadership” (Baccalaureate Degree, 2001) The education that patients get in how to care for themselves after leaving the hospital leads to better outcomes once they are gone and less recurrence of

"Brenner (1984) described the 5 stages of development for the professional nurse. The stages are (1) Novice (2) Advance Beginner (3) Competent practitioner (4) Proficient practitioner (5) Expert Practitioner. The stages progress from a nursing student to the professional practitioner through growth and knowledge." (Lopez-Boyd, 1997, p. 41) Nursing is a profession. Look around you, you see competent, caring individuals