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Clinical Career Ladders in Healthcare

Introduction and Background

Nurses are and have always been an essential part of the health system; therefore, it is extremely important to provide them with continuous and high-quality education. Clinical Ladder Programs, or CLPs, are strategies that healthcare facilities use to enable working nurses to increase their professional roles, build new skills, and develop their careers. The system of clinical ladder programs became popular in the 1970s and was claimed to have been caused by the widespread shortage of registered nurses in US hospitals (Coleman and Desai). Since then, these programs have turned into a common practice in many hospitals because they allow nurses to remain in their current settings, providing them with career advancement opportunities. Throughout various studies and research literature, advancement programs for nurses used names that differ insignificantly: clinical ladder program, clinical career ladder, professional development and advancement model, etc. Within this essay, the term “clinical ladder program” will be utilized.

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Statement of the Problem

Based on the experience and impacts of implementing clinical career programs, researchers have identified two critical concepts that make a CLP successful. CLPs should increase nurses’ personal professionalism and be clinically meaningful (Moore et al.). It is essential to recognize the impact of nurses because the lack of recognition negatively affects their job satisfaction and leads to a decrease in organizational retention. Improving the understanding of how all these factors interact and contribute to a successful implementation of CLPs can help to ensure their further development in hospitals nationwide. Although particular training strategies across clinical ladder programs may vary, the challenges that nurses face are reported to be similar (Rubio et al.). For example, young nurses can often get overwhelmed with the demands of the system they enter; as a result, they get frustrated and may start thinking about a different career path.


The purpose of this essay is to determine how successful clinical ladder programs can increase nurses’ job satisfaction and what factors contribute to the success of such programs. Studies on clinical career ladders have been used to evaluate the positive or negative impact of nurses’ participation in advancement programs. The changes required to improve the programs and encourage nurses to participate in them are identified.

Research Design

This paper uses a descriptive research design to obtain, describe and analyze information about the current state of the phenomena in question, i.e., CLPs, as well as all the variables and conditions of it. To measure and observe how different strategies and factors are connected to different outcomes within the framework of CLPs, a systematic search was conducted, which allowed identifying essential elements of a successful program. The databases used included PubMed, EBSCO, HSPC, and Elsevier. Keywords were used during the search, such as clinical ladder program, nursing career ladder, job satisfaction, and nursing career advancement. The articles used in the present study date from 2017 to 2021.

Data Analysis

Most studies used questionnaires and job satisfaction scales as the main measurement tools, with researchers asking nurses to report on a number of factors that influence their job satisfaction. Liu and Aungsuroch have examined the influence of burnout on quality nurse care and found that this influence is large, direct, and highly negative (942). Kim et al. have collected data “using a clinical competence tool” developed in their study and “existing methods such as the nursing professionalism evaluation tool, peer reviews, and face-to-face interviews to evaluate promotions and verify the presented content in a medical institution” (186). They then used second-generation statistical techniques to model “simultaneous relationships among multiple constructs.” A study by Hariyati and Safril used Descriptive and Correlation Spearmen to analyze the data collected and find out the correlation (144). They focused on the patient-to-nurse ratio, which was identified as one of the main determining factors contributing to job dissatisfaction among nurses. Therefore, the problem of high patient-nurse ratios needs to be addressed to improve the programs in the future.


The majority of studies examining the connection between a successful clinical ladder program and job satisfaction among nurses show that continuous education and involvement in improving current CLPs is essential for nurses. The study by Coleman and Desai showed that “nurses who participate in the clinical ladder at any level are overall satisfied with their job.” Thus, 65.38% of them said they were satisfied, and 15.38% said they were very satisfied (47). 48.08% of nurses say they “feel a sense of empowerment on their unit,” and 73.08% said that they “feel free to express their opinions, contribute ideas and set personal goals in the workplace” (47). This, in turn, increases retention rates: 40.38% of the nurses said they intended to stay in their current position. The other 30.77% wanted to “stay in the nursing field, but leave direct patient care at the bedside” (Coleman and Desai 47). Therefore, the needs of bedside nurses have to be addressed to increase their job satisfaction and retention rates as well.

At the same time, studies have shown that there is a lack of cost-benefit analyses of clinical ladder programs (Meucci et al.). Such analyses are important to prove that these programs are valuable in order to achieve the goals of each particular health care institution. A positive correlation has been found between the continuous professional development (CPD) and the satisfaction of nurses, “whereas a negative correlation was found between perceived implementations career with satisfaction” (Hariyati and Safril 146). In addition, the study discussed by Coleman showed that only 30 out of 68 nurses “worked at a hospital with the clinical ladder program instilled,” while the nurses’ “total perception of the clinical ladder program from a 1-5 scale was 3.44” (par. 7).

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To improve the programs and make nurses more interested in entering them, several recommendations can be applied by healthcare institutions. First, the description and terminology of each program need to be “consistent with intent” (Moore et al. 269). Second, implementation of the program has to be driven by bedside nurses, including “both continuous education and refinement of program requirements and incentives” (Moore et al. 269). Third, mandatory attendance of the programs may show positive implications, which would allow healthcare facilities and regulators to make CLPs more targeted and effective.

The results of the studies discussed show a wide range of impacts of career ladder programs for nurses. First, CLPs provide nurses with improved qualifications, thereby “promoting their career advancement.” (Pertiwi and Hariyati 109). Second, when nurses improve their skills, they get better at managing different groups of patients and “complex patient care, be it in the chronic or acute condition” (Hariyati and Safril 148). Finally, clinical ladder programs make nurses more aware of their duty. By participating in a CLP, nurses learn to think rationally, use their experiences as the opportunity to learn, develop “achievement portfolios,” and apply them “to the next step of their career ladders” (Pertiwi and Hariyati 109). To encourage nurses to participate in the programs, healthcare institutions can apply more effective reward systems, which would increase participation and lead to better staff retention rates.

Limitations to the studies are mostly connected to the nature of measurement tools utilized. Self-reported questionnaires have a tendency to overestimate or underestimate “the value of study variables” (Lui and Aungsuroch 943). The recommendations for future research revolve around the fact that the majority of existing studies are evaluative and “have flaws for understanding more complex relationships” (Moore et al. 268). Therefore, future research can focus more on the ways to enhance these programs to meet all intended goals. Constantly improved career ladder programs, as well as other clinical leadership programs, will attract nurses and keep them interested in always aiming at personal and professional growth.

Works Cited

Coleman, Y. A., and R. Desai. “The effects of a clinical ladder program on professional development and job satisfaction of acute care nurses.” Clinical Journal of Nursing Care and Practice, 2019, pp. 44-48.

Esfahani, Shervin, et al. “Use of the clinical ladder to improve capacity for nursing research.” Applied Nursing Research, vol. 55, 2020, p. 1512-1518.

Hariyati, Rr. T., and Satina Safril. “The relationship between nurses’ job satisfaction and continuing professional development.” Enfermería Clínica, vol. 28, 2018, pp. 144-148.

Kim, Yeon H., et al. “Development and validation of a nursing professionalism evaluation model in a career ladder system.” PLOS ONE, vol. 12, no. 10, 2017, p. 186.

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Knoche, Erin L., and Joanne H. Meucci. “Competencies Within a Professional Clinical Ladder.” Journal for Nurses in Professional Development, vol. 31, no. 2, 2015, pp. 91-99.

Liu, Ying, and Yupin Aungsuroch. “Factors influencing nurse-assessed quality nursing care: A cross-sectional study in hospitals.” Journal of Advanced Nursing, vol. 74, no. 4, 2017, pp. 935-945.

Meucci, Joanne, et al. “Testing Evidence-Based Strategies for Clinical Ladder Program Refinement.” JONA: The Journal of Nursing Administration, vol. 49, no. 11, 2019, pp. 561-568.

Mijares, Ann H., and Patricia Radovich. “Structured Mentorship and the Nursing Clinical Ladder.” Clinical Nurse Specialist, vol. 34, no. 6, 2020, pp. 276-281.

Moore, Abigail, et al. “Attributes of a Successful Clinical Ladder Program for Nurses: An Integrative Review.” Worldviews on Evidence-Based Nursing, vol. 16, no. 4, 2019, pp. 263-270.

Pertiwi, Bela, and Rr. T. Hariyati. “The impacts of career ladder system for nurses in hospital.” Enfermería Clínica, vol. 29, 2019, pp. 106-110.

Rubio, Doris M., et al. “Creating effective career development programs.” Journal of Clinical and Translational Science, vol. 1, no. 2, 2017, pp. 83-87.

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