LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

Nursing Clinical Ladder

Clinical Practice
Professional Development

Leadership

Evidence Based Practice

Professional

Identity

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

Opportunity Statement

LUHS implemented the Nursing Clinical Ladder in July 01. This program was developed to attract and retain nurses to direct patient care positions and to enhance nursing care by recognizing and utilizing nursing expertise. To achieve this objective we set a target to have 25% of eligible RNs recognized as level 3 or 4.

Project Goals:

To increase the number of RNs who participate (achieve level 3 and 4) to 25% of all eligible RNs. To make the application and maintenance process clearer for all eligible RNs.

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

Clinical Ladder Tutorial

All RNs in staff nurse positions must obtain level 2 within 18 months of employment. To be an eligible RN for level 3 & 4:

The Clinical Ladder structure provides staff nurses career advancement while remaining in direct patient care positions.

There are 4 levels within the Clinical Ladder: Level 1 Novice Nurse Level 2 Competent Nurse Level 3 Expert Nurse Level 4 Expert Nurse who impact care system-wide.

80% of work time must be in direct care activities. 0.5 FTE or more. Meet job requirements.

RNs must complete an extensive application packet for Level 3 & 4:

Applications are peer reviewed Recommendations for leveling are made to the chief nurse. Once leveled an RN must renew annually documenting continued advanced activity.

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

Domains of Nursing Practice included in the Clinical Ladder

Professional Development

Clinical Competence

Nursing Process Clinical Competence Management of the Continuum of Care

Mentor Knowledge Seeker

Quality/Evidence Based Practice

Leadership

Quality Improvement

Delegation
Collaboration Management of Environment

Professional Identity

Professionalism Communication

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

Reasons Why RNs Do Not Apply or Maintain Level 3 or 4

Focus groups of staff nurses identified the following:

The application process was intimidating for RNs who had never applied.

The reapplication process was identical to the application

process, which felt unnecessary and frustrating. Most communication about the clinical ladder process was general. RNs lacked tools to connect their clinical activities and expertise to the clinical ladder criteria.

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

Established an Ambassador Committee

The Ambassador Committee:

Developed an application folder with step by step directions. Distributed folders at the Nurses Week luncheon. Designated a liaison for each clinical area as a ready resource to peers. Provides information and packets to RNs when their orientation is complete. Holds Application Workshops to assist in application development.

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

Simplified Reapplication Process

The Clinical Ladder Review Committee:

Developed a simplified application.

Reduced amount of required documentation. Maintained requirement to demonstrate continued qualification for advanced levels.

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

30

Clinical Ladder Participation Clinical Ladder Participation

28

26 Target = 25% Target = 25% 24

Implemented Ambassador Committee

Percent Participation
22
UCL = 20.64 UCL = 20.64

20

18

Mean = 17.81

16
LCL = 14.99

LCL = 14.99 14

Implement Ambassador Committee

12

10

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

14

NewNew RNs Leveled in Clinical RNs Leveled in Clinical Ladder Ladder

Implement Ambassador Committee

12

10 # New RNs Leveled # New RNs Leveled

Mean = 6.89 Mean = 6.89

6

Implement Ambassador Committee

2

LOYOLA UNIVERSITY HEALTH SYSTEM

Loyola University Chicago

Conclusion & Next Steps:

Next Steps:
Evaluate Clinical Ladder

Conclusions:

Contribution of Ambassador Committee has made significant impact. Therefore, continue peer to peer ambassador activities. The simplified reapplication was well received by staff and the Review Committee found it documented continued performance at levels 3 and 4 well.
Continue to utilize Review Committee and staff nurse feedback to enhance program.

Program:
Compare Employee opinion survey Nurse Profile - pre & post implementation. Correlate Nurse sensitive quality indicators with distribution of Level 3 & 4 RNs once achieve 25% participation.
Publish and/or present results.