Clinical Advancement Program Research Articles

Beyond a Clinical Ladder: A Career Pathway for Professional Development and Recognition of Oncology Nurses.

Nurses at this Magnet®-recognized, National Cancer Institute-designated comprehensive cancer center restructured an existing clinical ladder program based on Benner's model and implemented an evidence-based progressive career development program for staff nurses. The revised program defines structured performance expectations and requirements for promotion and role maintenance, which encourage individual engagement and accountability. This article describes the creation and implementation of the clinical advancement program as well as outcomes of the 1st 10 years of the program.

Redesigning a Clinical Advancement Program to Promote and Strengthen Competencies of Clinical Nurses.

Clinical advancement programs (CAPs) benefit direct care nursing staff, patients, and healthcare institutions. As standards in nursing practice and workforce evolve, changes in CAPs are necessary. In this quality improvement project, nursing leadership and a 15-member nurse committee redesigned a CAP using Benner's Novice to Expert Model. Changes included self-selection of specialty tracks by shadowing senior nurses in direct patient care, education, and leadership. CAPs increase satisfaction, collaboration, and generation of innovative knowledge.

HSR22-132: Evolution of an Advanced Practice Provider (APP) Clinical Advancement Program (CAP): From Development and Implementation to Present

"HSR22-132: Evolution of an Advanced Practice Provider (APP) Clinical Advancement Program (CAP): From Development and Implementation to Present" published on 31 Mar 2022 by National Comprehensive Cancer Network.

Development and testing of an advanced practice clinical advancement program within an academic medical center.

Faculty advanced practice registered nurses (APRNs) and physician assistants (PAs) employed by Vanderbilt University Medical Center (VUMC) have historically participated in rank promotion tracks for recognition of professional accomplishments in education, practice, and research. However, there has not been a clinical advancement program for nonfaculty practitioners. Satisfaction, engagement, and health surveys indicated VUMC APRNs and PAs were seeking opportunities for professional growth and development. Many health care organizations have incorporated clinical advancement programs as key recruitment and retention strategies. With a growing number of nonfaculty APRNs and PAs, VUMC began to explore the development, implementation, and evaluation of a clinical advancement program. A VUMC Clinical Advancement Task Force was created to explore, develop, implement, and evaluate an advanced practice clinical advancement pilot. Two teams were selected to participate in a 6-month pilot. Presurveys and postsurveys were conducted, and postpilot focus groups were held with participating practitioners. A 9-square tool was developed as a rubric for evaluating the practitioner's progress. Applications, leader assessments, and recommendations were housed in a secure database for a selected advancement committee to evaluate. Of 23 participants, 47% indicated satisfaction with professional development opportunities, when compared with 84% postpilot. Postpilot focus groups further improved the tool and the process for the program. Opportunities for advancement/professional development positively influence APRN and PA perceptions of job satisfaction. This program could be tested with other APRN and PA teams for impact on job satisfaction, engagement, and retention.

Evaluation of the Clinical Competency Advancement Program

Introduction: A major challenge facing nursing administrators and recruiters is the recruitment and retention of bedside nurses. Clinical career ladder programs are used as recruitment and retention tools by many hospitals. The Clinical Competency Advancement Program (CCAP) is a clinical career ladder program developed by a health system in South Florida to help retain clinical nurses at the bedside. The purpose of this study was to assess nurses’ attitudes related to the CCAP, by both participants and non-participants, to determine the perceived barriers and benefits of the program.

CE: Original Research: Creating an Evidence-Based Progression for Clinical Advancement Programs.

The aim of our study was to validate the eight identified competencies and 186 related KSAs and determine their developmental progression within a clinical advancement program. Using the Delphi technique, nursing leadership validated the newly identified competency domains and KSAs as essential to practice. Clinical experts from 13 Magnet-designated hospitals with clinical advancement programs then participated in Delphi rounds aimed at reaching consensus on the developmental progression of the 186 KSAs through four levels of clinical advancement. Two Delphi rounds resulted in consensus by the expert participants. All eight competency domains were determined to be essential at all four levels of clinical practice. At the novice level of practice, the experts identified a greater number of KSAs in the domains of safety and patient- and family-centered care. At more advanced practice levels, the experts identified a greater number of KSAs in the domains of professionalism, teamwork, technology and informatics, and continuous quality improvement. Incorporating the eight competency domains and the 186 KSAs into a framework for clinical advancement programs will likely result in more clearly defined role expectations; enhance accountability; and elevate and promote nursing practice, thereby improving clinical outcomes and quality of care. With their emphasis on quality and safety, the eight competency domains also offer a framework for enhancing position descriptions, performance evaluations, clinical recognition, initial and ongoing competency assessment programs, and orientation and residency programs.

The Design and Redesign of a Clinical Ladder Program: Thinking Big and Overcoming Challenges.

Clinical Ladder Programs or Clinical Advancement Programs (CAPs) are an essential component of staff nurse professional development, satisfaction, and retention. There is a need for more evidence regarding developing CAPs. CAP initially launched in 2004. Nurses accomplished tasks in four main areas: clinical, education, leadership, and research, which reflected and incorporated the 14 Forces of Magnetism. In February 2012, the newly revised program was launched and renamed Professional Nursing Development Program. The new program was based on the 5 Magnet® model components, the Synergy Professional Practice Model, and a point system which enabled nurses to utilize activities in many areas, thereby allowing them to capitalize on their strengths. The purpose of this article is to discuss the development, revision, implementation, and lessons learned in creating and revising CAP.

Implementation of a Professional Portfolio: A Tool to Demonstrate Professional Development for Advanced Practice

The literature has a gap related to professional development for APRNs. In the United States, many health care organizations use clinical advancement programs for registered nurses, but APRNs are not often included in these programs. If APRNs are included, advancement opportunities are very limited. At CMC, implementation of a professional portfolio resulted in increased satisfaction among APPs regarding their ability to showcase professional growth and expertise, as well as the uniqueness of their advanced practice. Use of the professional portfolio led to improved recognition by APS and organizational leaders of APP performance excellence during the annual performance evaluation, as well as improved recognition among APP colleagues in terms of nominations for honors and awards.

Enhancing RN Professional Engagement and Contribution: An Innovative Competency and Clinical Advancement Program

In October 2010, the Institute of Medicine's (IOM) landmark report The Future of Nursing: Leading Change, Advancing Health was published. 1 Nursing leadership teams in all institutions and educational settings are being asked to explore the nurse's role and how it must evolve to meet the challenges of current and future quality care expectations.

A Streamlined Clinical Advancement Program Improves RN Participation and Retention

Retaining expert nurses in direct care is essential to quality patient outcomes. The goal of the clinical advancement program at Cincinnati Children's Hospital Medical Center has always been to recruit, retain, recognize, and reward nurses in direct care. A program revision in 2002 markedly increased nursing promotions and a higher retention rate for program participants versus their peers' retention rate of 88%. Nearly 40% of the hospital's nurses now participate in the program.

A Clinical Ladder for Occupational Health Nurses

Occupational health nurses must have a growing, expanding knowledge base to remain current in practice. The American Board for Occupational Health Nurses, Inc. encourages advancement with the availability of certification examinations. Health care centers support clinical advancement programs for bedside nurses. Nurses who continue their education either through a degree program or via continuing education or certification advance up the clinical ladder, receiving a higher salary, recognition from their peers, and perhaps even financial assistance to continue climbing, yet occupational health nurses do not have their own clinical advancement ladder. This article examines the steps necessary to develop a clinical ladder and presents a clinical ladder specific to occupational health nursing developed by the author.

A Clinical Ladder for Occupational Health Nurses

Occupational health nurses must have a growing, expanding knowledge base to remain current in practice. The American Board for Occupational Health Nurses, Inc. encourages advancement with the availability of certification examinations. Health care centers support clinical advancement programs for bedside nurses. Nurses who continue their education either through a degree program or via continuing education or certification advance up the clinical ladder, receiving a higher salary, recognition from their peers, and perhaps even financial assistance to continue climbing, yet occupational health nurses do not have their own clinical advancement ladder. This article examines the steps necessary to develop a clinical ladder and presents a clinical ladder specific to occupational health nursing developed by the author.

Certification and Clinical Ladder as the Impetus for Professional Development

With today's healthcare challenges of nursing shortages and financial instability, it is imperative that healthcare organizations retain clinically competent nurses at the bedside. Professional development and recognition are key motivators to increase nursing job satisfaction, thus reducing shortages and turnover. Implementation of specialty certification and clinical advancement programs is of benefit to the public, employers, and nurses alike. Clinical ladder and Magnet recognition are often the impetus for specialty nursing certification in healthcare institutions. Clinical ladder history, purpose, models, perceptions, and satisfiers are discussed. Certification statistics, types, impetus, benefits, incentives, and barriers are highlighted, as well as a facility's innovative strategy to increase specialty certification. Certification and clinical ladder programs demonstrate commitment of healthcare organizations and nursing staff to provide high-quality care and professional nursing development, an investment that hospitals cannot afford to overlook.

Promoting Professional Development: Three Phases of Articulation in Nursing Education and Practice

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.

Achieve: An Outcomes Based Clinical Advancement Program for Professionals

Achieve: An Outcomes Based Clinical Advancement Program for Professionals

A Clinical Advancement Program for Registered Nurses With an Outpatient Focus

Clinical advancement programs have been in use for almost 30 years. Although clinical advancement programs have been designed for many areas, it appears that one has never been developed specific to the outpatient-focused registered nurse. This article describes the development of a clinical advancement program for non-hospital-based registered nurses employed at the Guthrie Clinic in Sayre, Pennsylvania and highlights recommendations for instituting this program in any outpatient setting.

A clinical advancement program: evaluating 10 years of progressive change.

To report the evolution of a clinical advancement program, UEXCEL, at a western teaching hospital and the outcomes associated with evaluation over time. The clinical ladder program was initiated in 1989 to provide a professional framework for developing, evaluating, and promoting registered nurses. The program is derived from Benner's Novice to Expert model. Over a 10-year period, the program has undergone three significant revisions. Program evaluation data have been used to guide institutional change. Structure and progression of program development and change are outlined. Evaluation data were collected using a 23-item clinical ladder satisfaction scale developed by Strzelecki. Data were collected in 1993, 1994, 1996, and 1998 using standard survey methods after institutional review board approval. Subjects were registered nurses holding clinical positions at the University of Colorado Hospital. Data were trended across units and time periods and were compared with other institutional evaluation data sets. Improvement in nurse satisfaction with the UEXCEL program has been steady and incremental, after low baseline measurement. Satisfaction has improved after each program revision. A significant demographic variable over time is the correlation between higher registered nurse education and program satisfaction. Human resources issues are reported with data results. Sustaining a clinical advancement program represents a challenge in the current health-care environment. Institutional commitment, staff involvement in revisions, and activities to improve professional nurse development are critical strategies so progress can be achieved.

The Synergy Model: building a clinical advancement program

The Synergy Model: building a clinical advancement program

A clinical advancement program: creating an environment for professional growth.

Clinical ladders help maintain expert, motivated, and effective nurses in direct patient care roles. While many institutions were phasing out clinical ladders for registered nurses, Miami Valley Hospital was proactively evaluating the original version. The authors describe their clinical advancement program, based on Benner's model, with program evaluation results. The program participation rate has increased overall. Participants perceive their work and environment more positively than nonparticipants.

An interdisciplinary clinical advancement program within a patient-centered care model.

Restructuring in health care does not have to compromise the pursuit of clinical excellence and quality patient care. The clinical advancement program (CAP) at the Hospital for Special Care is a newly developed multidisciplinary reward and recognition program for clinical staff. The program is integrated into the hospital's structure of service line management and, unlike traditional advancement programs, is open to all levels of care providers: professional personnel, technical staff, and aides. This article describes the basic features of the CAP model and how its was developed by a multidisciplinary task force.