Abstract
In this article the authors present the evolution of career ladders in nursing education and practice and discuss their development, maturation, and institutionalization in three phases over a span of forty years. In phase one, academic career ladders were spiral staircases, complex, confusing, and poorly articulated entry and exit pathways. Phase two saw the maturation of career ladders across all levels of nursing education and practice. In phase three, academic and clinical career ladders, built upon theoretical perspectives, have enriched academic programs and clinical practice and increasingly are being integrated into the curriculum, clinical advancement programs, and the magnet hospital movement. The authors conclude by discussing continuing questions, such as the amount of clinical experience needed in an educational program and the amount of clinical practice needed before seeking an advanced degree. They highlight the need for more research and dialogue about the amount, type, and measurement of clinical work and argue that these studies are needed to better inform decisions about professional legislation, accreditation, certification, education, healthcare outcomes, and future-oriented career ladders.
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