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LOYOLAUNIVERSITYHEALTH SYSTEMLoyola University Chicago
ProfessionalProfessionalDevelopmentDevelopmentProfessionalProfessional
DevelopmentDevelopment
ClinicalClinicalPracticePracticeClinicalClinicalPracticePractice
EvidenceEvidenceBasedBased
PracticePractice
EvidenceEvidenceBasedBased
PracticePractice ProfessionalProfessional
IdentityIdentity ProfessionalProfessional
IdentityIdentity
LeadershipLeadershipLeadershipLeadership
Nursing Clinical Nursing Clinical LadderLadder
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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:
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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:
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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
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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
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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
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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
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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
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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
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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
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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