1. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago ProfessionalDevelopmentProfessionalDevelopment ClinicalPracticeClinicalPractice EvidenceBasedPracticeEvidenceBasedPractice Professional ProfessionalIdentity Identity LeadershipLeadership Nursing Clinical Ladder

2. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Opportunity Statement  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. 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:

3. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Clinical Ladder Tutorial 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. All RNs in staff nurse positions must obtain level 2 within 18 months of employment. To be an eligible RN for level 3 & 4:  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.

4. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Domains of Nursing Practice included in the Clinical Ladder Clinical 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

5. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Reasons Why RNs Do Not Apply or Maintain Level 3 or 4  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. Focus groups of staff nurses identified the following:

6. 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.

7. 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.

8. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Implement Ambassador Committee Clinical Ladder Participation

9. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago # New RNs Leveled New RNs Leveled in Clinical Ladder Jan-03 Apr-03 Jul-03 Oct-03 Jan-04 Apr-04 Jul-04 Oct-04 Jan-05 0 2 4 6 8 10 12 14 Mean = 6.89 Implement Ambassador Committee # New RNs Leveled New RNs Leveled in Clinical Ladder Jan-03 Apr-03 Jul-03 Oct-03 Jan-04 Apr-04 Jul-04 Oct-04 Jan-05 0 2 4 6 8 10 12 14 Mean = 6.89 Implement Ambassador Committee

10. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Conclusion & Next Steps: 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. Next Steps:  Evaluate Clinical Ladder 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.