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or Revision of Outdated Policy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.