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Testing Evidence-Based Strategies for Clinical Ladder Program Refinement

Meucci, Joanne MSN, RN; Moore, Abigail BSN, RN; McGrath, Jacqueline M. PhD, RN, FNAP, FAAN

JONA: The Journal of Nursing Administration: November 2019 - Volume 49 - Issue 11 - p 561–568
doi: 10.1097/NNA.0000000000000812

BACKGROUND Institutional objectives for clinical ladder program (CLP) implementation often focus on improving job satisfaction, retention rates, and patient outcomes. Local inconsistency in CLP implementation seemed to be contributing to decreased job satisfaction and nurse retention rates.

PURPOSE The aim of this study was to use current evidence and prevailing perceptions of bedside nurses and nurse managers to refine an existing CLP.

METHODS Pretest/posttest design was used to evaluate differences in perceptions of existing CLP (baseline) and perceptions 6 months after CLP refinements were initiated (post).

RESULTS Baseline perceptions of CLP implementation were significantly different for bedside nurses and managers. Bedside nurses were more dissatisfied than nurse managers. Perceptions became more similar across groups as initiatives were implemented to improve CLP understanding and as CLP implementation became more consistent across the organization.

CONCLUSIONS Targeted strategies tailored to increase understanding and consistent CLP implementation can be effective in improving CLP satisfaction and increasing bedside nurse professional behaviors.

Author Affiliations: Director (Ms Meucci), Inpatient Medical Surgical Services, Connecticut Children's Medical Center, Hartford; Staff Nurse (Ms Moore), Hartford Hospital, Connecticut; and Thelma and Joe Crow Endowed Professor and Vice Dean for Faculty Excellence (Dr McGrath), UTH San Antonio School of Nursing, Texas.

The authors declare no conflicts of interest.

This quality improvement project was supported in part by funding from the Office for Undergraduate Research at the University of Connecticut through an IDEA Grant.

Correspondence: Ms Meucci, Inpatient Medical Surgical Services, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106 (

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