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EXECUTIVE SUMMARY
* Clinical ladders, or career advancement systems, were designed to enhance professional development, provide a reward system for quality clinical performance, promote quality nursing practice, and improve job satisfaction among nurses.
* Most of the literature on RN clinical ladder programs is related to the acute care setting, where these programs originated; not much is known about their effectiveness in the ambulatory care environment.
* The RN Career Ladder at Kaiser Permanente of Colorado was begun by a Labor Management Partnership Committee in 2003, and awards financial incentives to RNs who demonstrate a commitment to continuing education, leadership activities, and program development on a local and regional level.
* In this study significantly more involvement in leadership, interdisciplinary, and quality improvement activities were found among career ladder nurses than non-career ladder nurses, regardless of their job role.
* It is not clear whether nursing leaders gravitate toward a career ladder or whether career ladder participation encourages increased participation in leadership activities.
DEVELOPED IN THE 1970S IN response to a national nursing shortage, clinical ladders, or career advancement systems, were designed to enhance professional development, provide a reward system for quality clinical performance, promote quality nursing practice, and improve job satisfaction among nurses. Indeed, these clinical ladders correlate with improved productivity and job satisfaction among acute care RNs (Schultz, 1993; Vestal, 1984). Most of the literature on RN clinical ladder programs is related to the acute care setting, where these programs originated; not much is known about their effectiveness in the ambulatory care environment.
The RN Career Ladder at Kaiser Permanente of Colorado (KPCO) was begun by a Labor Management Partnership Committee in 2003, and awards financial incentives to registered nurses (RNs) who demonstrate a commitment to continuing education, leadership activities, and program development on a local and regional level. The development of Kaiser Permanente's Career Ladder Program was based on a labor management partnership model which is based on collaboration, trust, and accountability. Labor and management partner in a relationship "where each person has equal status and a certain independence, but also a formal obligation to their constituents and to each other" (KPCO, 2005). Since organizational success is contingent upon the development and empowerment of employees, Kaiser Permanente is committed to providing...