LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

ProfessionalProfessionalDevelopmentDevelopmentProfessionalProfessional

DevelopmentDevelopment

ClinicalClinicalPracticePracticeClinicalClinicalPracticePractice

EvidenceEvidenceBasedBased

PracticePractice

EvidenceEvidenceBasedBased

PracticePractice ProfessionalProfessional

IdentityIdentity ProfessionalProfessional

IdentityIdentity

LeadershipLeadershipLeadershipLeadership

Nursing Clinical Nursing Clinical LadderLadder

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Opportunity Opportunity StatementStatement

Decreased patient length of stay Increasing patient acuity Impending nursing shortage Availability of non-patient care roles for

RNs

To attract and retain nurses to direct patient care positions

To implement a clinical ladder program with at least 25% eligible RN’s participating at levels 3 & 4

LUHS’s need to attract, develop and retain experienced, expert RNs in direct patient care positions has increased because of the following:

Project Goals:

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Reasons Why RNs Reasons Why RNs Leave Direct Patient Leave Direct Patient

CareCare

Lack of recognition for professional

expertise

Desire to develop and broaden

knowledge and skills

Limited promotion availability

Limited salary range

Focus groups of LUHS staff nurses identified the following reasons:

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Solutions Implemented Solutions Implemented by the by the

Oversight CommitteeOversight Committee Completed literature

review Interviewed UHC

Members with Clinical Ladder Experience

Agreed upon Benner’s “novice to expert” model

Developed program guidelines

Gained approval from LUHS Sr. Administration for clinical ladder salary structure

Solicited internal feedback

Finalized, implemented and copyrighted Clinical Ladder program

Implemented system-wide education plan» Video & Binder» Open Forums» Program on

Intranet Organized annual

pinning ceremony for level 3 & 4 RNs

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Solutions Solutions Implemented:Implemented:

Criteria Committee

Assembled staff RNs to develop practice specific criteria » Ambulatory» Homecare & Hospice» Inpatient» OR/PAR» Specialty

Developed application process

Review Committee

Developed review process

Reviewed applications and made leveling recommendations to Chief Nurse Executive

Recommended program revisions based on feedback

Maintain ongoing review

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Domains of Nursing Domains of Nursing Practice included in the Practice included in the

Clinical LadderClinical LadderClinical

Competence Nursing Process Clinical Competence Management of the

Continuum of Care

Professional Development

Mentor Knowledge Seeker

Leadership Delegation Collaboration Management of

Environment

Quality/Evidence Based Practice Quality

Improvement

Professional Identity

Professionalism

Communication

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Implementation of the Implementation of the Clinical Ladder is a Clinical Ladder is a

contributing factor to contributing factor to LUHS’s declining nursing LUHS’s declining nursing

turnover ratesturnover rates

10.511.7

13.116.3

14.014.6

18.9517.216.7

0

5

10

15

20

25

FY 00 FY 01 FY 02

LUHS

Regional

National

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

16% of eligible RNs are 16% of eligible RNs are participating in the participating in the

Clinical Ladder at Levels 3 Clinical Ladder at Levels 3 & 4& 4

1182

96 9

AmbulatoryHomecareInpatientOR/PARSpecialty

Clinical Ladder RNs participated in greater than 2300 hours of CEU’s in the past 12

months; 57 RNs function in clinical liaison roles to enhance quality of care

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Next Steps:Next Steps:Staff RN Staff RN

OpportunitiesOpportunities Involve Level 3 & 4 RNs in nursing

practice forums and practice standards development

Involve Review Committee staff nurses in program promotion and education

Revise criteria as needed based on staff RN and Manager feedback

Provide opportunities to educate RNs on Clinical Ladder program to achieve goal of at least 25% participation

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Next Steps:Next Steps:Program EvaluationProgram Evaluation

Correlate Nurse sensitive quality indicators with distribution of Level 3 & 4 RNs

Compare Employee opinion survey – Nurse Profile - pre & post implementation

Qualitative analysis of patient care RN exit interviews

Publish or present results

LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago

Thank You to our Thank You to our Teams:Teams:

Program Sponsor: Paula Hindle LUHS Sr. Administration for their

support of this program The Over 50 RNs who participated in

creating our Clinical Ladder Program

Oversight Committee: Paula Hindle, Chair

Criteria Committees: Sandy Swanson, Chair

Review Committee: Diane Deacy & Sue Flores, Co-Chairs