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–Clinical Ladder entry level for a new graduate bedside registered nurse.  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–After completion of a year of employment, and receiving a satisfactory PACE Evaluation, a bedside registered nurse will automatically advance to Clinical Nurse II level.A newly hired, experienced registered nurse (with at least 1 year of recent nursing experience) will be placed at a Clinical Nurse II level.  After first successful PACE evaluation, may advance to higher clinical ladder levels following all program requirements. All RN’s will remain at Clinical Nurse II level if they do not choose to advance to higher levels.

  Description–An experienced bedside registered nurse capable of independent patient care.  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:

Clinical Nurse III–Requires annual portfolio submission and complying with all clinical ladder program requirements. Advancement to this level requires self paced and self motivated participation.

  DescriptionA bedside registered nurse highly skilled in patient care.  Provides leadership and mentorship abilities. Active involvement in continuing education and in nursing activities beyond the basic job requirements and responsibilities.

Clinical Nurse IV–Requires annual portfolio submission and complying with all clinical ladder program requirements. Advancement to this level requires highly self paced and self motivated participation.

  DescriptionA bedside 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–Requires annual portfolio submission and complying 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.*Must be nationally certified in nursing specialty*

  DescriptionA bedside 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. Active and ongoing professional involvement in improving nursing through evidenced based practice, such as research activities, writing a published nursing article, etc.  All submitted Evidence Based Practice submissions 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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