CV Directions Vol. 1, No. 2 - Page 4

4 Table 1 Clinical Educational Professional Primary Charge Nurse Preceptor of New Staff Volunteer in Healthcare Fair Competency Validator Creation of Continuing Active Member in Professional Resource for Complex Skill Creation of Patient Teaching Board Member of Professional Teaching Formalized Class Active Participation in Unit­Based (i.e. Balloon Pump) Writing of New Policy or Revision of Outdated Policy Education Material Association (% of Attendance Proven) Written or Oral Presentation Within Hospital (i.e. ACLS, BLS, LVAD) Association Council or Hospital Committee Career Ladders: Staff Pay for Performance Deborah Stabell Tran Texas Health Presbyterian Hospital Dallas R ecruitment and retention in healthcare is an ongoing challenge—a financially difficult and time-consuming effort. Employers need to find innovative ways to incentivize employees to continue tenure. This is especially true with staff members working in a specialty, like cardiovascular services, where the more experienced staff are even more valuable and difficult to retain. This is where a multi-focal compensation plan is especially important, and payment for advancing in the profession via a career ladder comes into focus. Working in nursing, Patricia Benner (2001) developed an excellent theory to delineate the levels of nursing and therefore the ladder on which registered nurses can climb. Benner works with a novice-to-expert, five step system that allows for new graduate staff to rise to advanced-degreed professionals. When the Benner model was designed, the doctoral degree was not as prominent as it is now, therefore our system has added a sixth level for this practitioner. Our facility hires new graduate nurses as Level I – novices, and nurses with more than one year of experience as level II – advanced beginner. Our clinical ladder begins at level III, the competent nurse in the Benner Theory, and progressively offers an hourly differential based on the levels, doubling that hourly bonus for each level attained. Once a nurse meets basic participation qualifications (positive peer reviews, no performance issues and manager approval), they apply to work towards levels III, IV, V & VI. These levels are based on level of schooling, years of nursing experience, and service to the profession and our facility. We utilize a three pronged approach to measure their growth in the profession; clinical, educational, and professional (examples: Table I). Each category has multiple tasks the nurse can perform based on the level they are seeking, with more rigorous work required as one progresses up the advancement program. Once the nurse has applied to participate in our program, they meet with an educator that assists them in choosing activities in each category to develop a comprehensive portfolio. In addition to the categories, all nurses write a clinical exemplar on a special situation where they advocated for a patient. Once the planning phase is over, the nurse has a year to perform the projects and submit the portfolio to an approval committee. Our team that reviews packets consists of frontline staff from all areas of the hospital, as well as educators, managers and directors. This ensures an equitable review for staff members of different service lines. Once approved, the nurse receives the hourly raise, to be renewed on an annual basis, and is further recognized by an annual banquet where they receive a certificate of congratulations from their chief nursing officer. The staff member also receives a gold pin signifying the level achieved. While we currently are only utilizing our career ladder for nurses, we are attempting to find a way to implement this system across disciplines. We are exploring experts for each type of healthcare provider that can assist with the definition of growth for our other members of our healthcare team. Another challenge of career ladders is whether this is only a reward available to direct care staff or if clinical support staff should be included as well. The current issue is that support staff already perform some of the listed activities, and should those nurses be financially rewarded for tasks within their job role? The last item is the ability to involve staff and get them engaged in the program. The financial incentive does not always get the attention of the right staff, therefore good support of the program from top administrators is key to ensuring staff participation is meaningful for the facility. Benner, P. (2001). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Upper Saddle River, New Jersey: Prentice Hall Health.