Helping Nurses Climb the Clinical Ladder

Does your organization have a process for clinical advancement? Do many nurses pursue advancement, or do they feel there are barriers?

At Yale-New Haven (CT) Hospital, Pina Violano, MSPH, RN-BC, CCRN, PhD(c), was concerned that too few nurses took advantage of the clinical advancement program offered by her organization. Violano is now the injury prevention coordinator for the trauma department, but at the time she was a clinical nurse educator in the Center for Professional Practice. She says only 50% of nurses participated in the program and less than 0.2% achieved Clinical Nurse IV, the highest level of practice (Pellico & Violano, 2010). As a result, she felt there was a serious problem.

“As an educator, I was concerned that so few nurses were completing the application process to advance clinically,” says Violano. “I believed that nurses needed a voice to prepare themselves to attempt clinical advancement.” 

She realized that nurses needed help preparing their application portfolios for advancement, which consist of a letter of intent, clinical narrative or exemplars, curriculum vitae (CV), a self-evaluation, and clinical practice goals. A completed portfolio is submitted to a formal committee that meets four times per year to review applications. 

For nurses to begin the advancement process, the first step is to inform their manager of their plan to apply by submitting a letter of intent. After the manager gives the okay, nurses prepare the portfolio. 

“I found that many nurses were intimidated by the process,” says Violano. So she developed a formal, daylong class where nurses could gather and work on the application process.