RN IV tier completes Nursing Clinical Ladder

RN IV tier completes Nursing Clinical Ladder

On the leading edge of professional development for nurses, Christiana Care Health System has added a fourth tier to the Clinical Ladder professional practice model. The new “Expert Clinician” level provides nurses with even greater opportunity for advancement and ensures an even safer environment for patients.

“We’ve anticipated four tiers since the Clinical Ladder was first introduced in 2002,” said Dot Fowler, MSN, APRN, RN-BC, nursing professional advancement coordinator.Christiana Care is the first health care institution in Delaware to establish a Clinical Ladder.

Two nurses monitor a cardiovascular patient.
Kimberly Wagner Vignola, BSN, RN III, CCRN, helps Kristen Clark, RN II get oriented as she transitions from 4B to the Cardiovascular ICU.

The program is based on the American Association of Critical Care Nurses Synergy Model. It recognizes the unique relationship between nurses and patients, and demonstrates the direct correlation between years of experience and patient safety. Over the years, the Clinical Ladder has evolved and expanded significantly.

Today, nurses begin on the Clinical Ladder at RN I — the Novice/Advanced Beginner level — which represents new hires with less than six months of nursing experience. With a focus on training and education at this level, nurses are encouraged to learn, collaborate, participate and build on their personal commitment and professionalism.

To reach the RN II level of “Competent,” nurses must meet rigorous performance expectations in the categories of clinical, core values, behaviors, attendance and mandatory education, and must demonstrate increased knowledge, professionalism, teamwork and an evidence-based practice. To achieve Level III —“Proficient”— nurses must hold a BSN or MSN, have three years of acute or sub-acute nursing experience and two years in a specialty, be viewed as a role model, have completed required workshops as well as the nursing mentoring program, demonstrate ongoing involvement in unit goal achievement and more.

Kimberly Wagner Vignola, BSN, RN III, CCRN
Kimberly Wagner Vignola, BSN, RN III, CCRN, is among the
RN IIIs who have applied for advancement to the new
RN IV tier.

“Nurses who have risen to the RN III level of the Clinical Ladder are truly making a difference,” said Fowler. According to the 2010 “Future of Nursing” report from the Institute of Medicine, research shows that nurses with BSNs have better clinical outcomes. As such, the American Nurses Credentialing Center has raised the standard, stating that to earn Magnet Designation —
the highest level of national recognition for sustained nursing excellence — an institution must achieve an 80 percent BSN rate among its nurses by the year 2020.

Just as the Professional Advancement Council was preparing to launch the RN IV tier, Christiana Care reached a major milestone. On Oct. 16, Kenneth Mack, BSN, RN-BC, became the 500th nurse at Christiana Care to achieve the RN III level. A psychiatric crisis nurse and former Army medic, Mack joined Christiana Care in 2006 and works with psychiatric patients at both Christiana Hospital and Wilmington Hospital.

“There are so many opportunities for learning here at Christiana Care. Being the 500th RN III feels great!”
— Kenneth Mack, BSN, RN-BC

“I have wanted to be an RN III for some time now,” said Mack. “I was becoming
increasingly involved in conducting research and participating in other key projects, and it gave me an appetite to do more in the non-clinical area and for Christiana Care overall. I recently earned my board certification from the ANCC, and that wouldn’t have happened if not for the Clinical Ladder.”

Christiana Care offers tuition assistance, including pre-pay options to support continuing professional development and education. To be eligible for the RN IV level, a nurse must be an RN III for at least two years, have five years of acute or sub-acute nursing experience and at least three years in his or her specialty, hold a master’s degree, have served as a chair or project leader of a council or task force, be acknowledged as a role model to peers, be active in a relevant professional organization, and serve as a volunteer in community activities, among other criteria. As with the other tiers of the Clinical Ladder, selections are made by a panel of Christiana Care nurses and nurse leaders.“Christiana Care remains on the leading edge of professional development,” said Fowler. “The RN IV level — the highest level of professional and clinical practice — is the natural next step for our Clinical Ladder and our nurses.”

The application process for the new RN IV tier opened in November. Interviews are under way, along with professional development for this level. Fowler anticipates that 25 to 30 eligible nurses will apply immediately. Among them is Marsha Babb, MS, BSN, RN III, CNOR, a cardiac operating room nurse who joined Christiana Care in 1995. Babb formerly chaired Christiana Care’s Professional Advancement Council for nurses and is now a lifetime member.

Marsha Babb, MS, BSN, RN III, CNOR
Marsha Babb, MS, BSN, RN III, CNOR, former Professional Advancement Council chair,
has helped lead the initiative
to complete Nursing’s Clinical Ladder.

“The RN IV level is a dream for me,” said Babb, who was instrumental in establishing the criteria for the new tier along with 150 of her peers. “Desire and commitment make a great nurse. A growth mindset makes a great nurse. Meeting challenges with hard work makes a great nurse. I have grown because I have been given the opportunity to do so, and as a result of the Clinical Ladder, I continue to refine my practice.”

Anita Symonds, MS, BSN, RN, SANE-A, SANE-P, an ED nurse who joined Christiana Care in 1998 and is also a member of the Professional Advancement Council, echoed Babb’s sentiments.

“I’ve had my eye on the RN IV for a while,” said Symonds. “The Clinical Ladder motivates bedside nurses to advance our level of professionalism, increase compensation, further our education, and still remain at the bedside. We’re always delivering excellent care, and this encourages us to take it to another level. The hospital benefits greatly as we share our knowledge with our peers. And having more bedside nurses invested in department and systemwide goals ultimately results in better care for the patients. It’s a win-win for everyone.”

“Christiana Care remains on the leading edge of professional development. The RN IV level — the highest level of professional and clinical practice — is the natural next step for our Clinical Ladder and our nurses.” — DOT FOWLER, MSN, APRN, RN-BC, Nursing Professional Advancement Coordinator“The Clinical Ladder showcases the extraordinary talent of our nurses and recognizes their exceptional value to the organization,” said Kimberly Wagner Vignola, BSN, RN III, CCRN, staff nurse in the Cardiovascular Critical Care Complex, and chair, Professional Advancement Council. “Research shows that the Clinical Ladder keeps great nurses at the bedside and ensures they feel valued. And because of that higher level of expertise across the organization, patients are safer. The new RN IV level provides incentive to strive for even greater expertise.