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  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:

3. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Reasons Why RNs Leave Direct Patient Care  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:

4. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Solutions Implemented by the Oversight 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

5. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Solutions 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

6. 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

7. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Implementation of the Clinical Ladder is a contributing factor to LUHS’s declining nursing turnover rates

8. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago 16% of eligible RNs are participating in the Clinical Ladder at Levels 3 & 4 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

9. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Next Steps: Staff RN Opportunities  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

10. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Next Steps: Program 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

11. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Thank You to our 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