186 A . K . Blakey : J Extra Corpor Technol 2024 , 56 , 185 – 190
Rationale for creating a professional advancement model
PAMs effectively reduce yearly turnover among APPs , reducing 13.8 % to 5 % over four years after implementation [ 4 ]. In the same study , participants in the PAM program were found to have broad support for the process . Similarly , another study showed a decrease in organizational APP turnover rate from 22 % before PAM implementation to 5 % after [ 13 ].
A survey of 162 nurses who were part of a clinical advancement program for an extensive academic health system found overwhelming positivity about the impact on a nurse ’ s career [ 10 ]. Most respondents agreed that the advancement program helped them grow professionally and positively impacted employee satisfaction and retention of nurses . Another survey of 157 APPs found that most respondents either agreed or strongly agreed that an organizational PAM made them more interested in seeking professional opportunities and strengthened their clinical practice [ 14 ].
Implementing a PAM for APPs helps increase APP visibility at the organizations where they work and publicly through increased journal publications and conference presentations [ 13 ]. In the same study , after implementing a PAM for APPs , the authors found that abstract submission to a regional conference more than doubled from 20 in year one to 45 in year three [ 13 ].
Framework for developing a professional advancement model
McComiskey et al . presented the APP PAM implementation in their organization [ 4 ]. The authors first surveyed APPs in the organization ’ s desire to seek professional advancement opportunities . The PAM consisted of a four-tier model : Level I , Level II , Senior I , and Senior II . Requirements for Level I included entry-level skills and less than one year of experience . Level II can be obtained by having more than one year of experience and obtaining specialty certifications . Senior I must have an excellent annual performance review before applying . The Senior I applicant must meet well-defined clinical and leadership metrics , such as leading a quality improvement initiative or publishing an article . In addition to the requirements of the lower levels , Senior II must also demonstrate more advanced leadership and clinical metrics , such as holding a leadership position in a professional organization and grant proposal submission . Implementation of the PAM consisted of Levels I and II automatically being given to APPs who met the criteria . For Senior I and II , participants must submit applications to a PAM committee consisting of APPs who evaluate each applicant and either approve or deny the promotion . Senior I and II both experienced a 5 % salary increase .
Warman et al . describe redesigning a clinical advancement program for nurses created eight years prior [ 10 ]. The redesign included a two-tier model : Levels II and III . The framework consisted of the following categories in which the nurses must meet specific metrics : Exemplary professional practice , transformational leadership , structural empowerment , and new knowledge , innovation , and improvements . A point system was created where points were assigned to specific tasks within each category . For example , enrollment in a master ’ s program , becoming a preceptor , giving a poster presentation , and journal club participation are examples of tasks within each category . Level III had a higher point requirement than level II , and minimum point requirements within each category were required . To be eligible for Level II , nurses must have been employed for at least one year and exceeded performance evaluation standards . Advancing to Level III requires employment in their clinical area for at least five years and must reach Level II before applying for Level III . Participants must submit their portfolios to a committee consisting of nursing leadership , where they either approve or deny the promotion . An appeals processisalsoinplaceforthosewhofeeltheywerewrongly denied . Level II experienced a 5 % salary increase , and Level III experienced a 10 % increase .
Ko and Yu describe a nursing clinical ladder implementation that stresses the importance of presenting leadership and administration with estimated costs and getting approval before beginning the work [ 12 ]. After approval , the article describes the implementation of a four-level PAM . A minimum of one , three , five , and seven years of experience were required for promotion to levels one , two , three , and four , respectively . Level one did not have any additional requirements . Level two must have evaluated well , participated in nursing education programs and committee activities , and taken various learning courses . In addition to the requirements of Level two , Level three required a bachelor ’ s degree , excellent performance evaluations , and obtained certifications related to nursing . Level four required all of the accomplishments of lower levels , a master ’ s degree , and a research publication . Rewards for each level were tuition reimbursement , an additional two days of vacation time , and promotion to unit manager for levels two , three , and four , respectively .
A five-level conceptual clinical ladder model for PAs was developed by Boyd et al . [ 15 ]. In this conceptual model , an applicant could obtain points across the four categories : clinical practice development , clinical leadership , clinical scholarships , and clinical service . Specific activities include enrollment in a specialty certificate program , membership in a professional PA organization , publication in a scholarly journal , and participation in a non-clinical community-based volunteer project . The proposed requirements for each level were none for PA I , three years of experience plus ten criteria points for PA II , five years of experience plus 12 criteria points for Senior PA , seven years of experience plus 15 criteria points for Chief PA , and eight years of experience plus 15 criteria points for executive PA .
The research by Burket et al . describes the application and renewal process for a clinical ladder for nurses [ 16 ]. Applicants must first fill out an application that includes , among other things , a self-evaluation and a demographic profile . Applicants must then select a coach and submit their application along with a curriculum vitae ( CV ), three letters of recommendation , and a letter of intent for which level is being applied . Documentation supporting the accomplishments that qualify the applicant for the level to which they are applying is also required . A committee reviews the material and then formally interviews the applicant , resulting in either a promotion or denial . To maintain the current level on the ladder , nurses must renew their level by