Clinical Ladder program helps RNs grow

Bev Misuna and several other nurses at Shore Memorial Hospital recently joined forces to improve the way medications are administered to some chronically ill patients.

The result: state-of-the-art equipment and new procedures that translate into better results for those who suffer from conditions such as anemia.

"Knowing this is going to help deliver patient care a lot better, I’m all for it,” Misuna said.

The effort may also benefit the nurses themselves, thanks to a new system that rewards RNs involved in safety improvements – as well as those who excel at customer service or pursue educational goals.

Shore Memorial Hospital’s Clinical Ladder was launched March 1. The voluntary system contains five levels designed to correspond with a nurse’s experience and education. Points are awarded for accomplishments, such as participation on a safety committee, advances in education and customer service.

As nurses accrue enough points to progress up the ladder, they earn bonuses.

“This is above and beyond their yearly evaluation,” said Beth Perry, Shore Memorial Hospital’s director of clinical education. “This is what sets them apart.”
    
In fact, growth is the focus of the Clinical Ladder, developed over several years by hospital staff, including Perry and Senora Ruffin, director of the hospital’s Maternal Child Health unit.
    
“The intent is to retain superior nurses at the bedside,” Ruffin said.
    
The program encourages RNs to get involved – and even create – safety and improvement initiatives instead of sitting back and waiting for administrators to make decisions.
     
“It helps foster grassroots efforts,” Perry said. “It’s not a top-down kind of thing. It’s a bottom-up kind of thing. It expands their knowledge of how our organization runs.”
    
Nurses are often left out of financial decisions, for example. And they typically don’t focus on the billing side of the healthcare equation.

But Misuna and her group had to cross those boundaries when they began noticing that chronically ill patients who were returning to the hospital repeatedly were having trouble getting medications through a regular IV.
    
That’s because caustic drugs, such as antibiotics, can wear down veins. That led nurses to prick the patient, to establish a new IV line in the hand, again and again.
    
Or they had to call a doctor to install a central venus catheter, usually into the neck. CVC lines delivered medications better, but they were also more likely to lead to infection.
     
“What we were finding is that instead of going from the hand to the neck there is a catheter that can be placed by nurses,” Misuna said.
     
The line could remain in place, in a patient’s upper arm, for weeks or months as a safe and easy-access portal for delivering medications. “They don’t have to come in and keep getting re-stuck,” Misuna said. “It’s less trauma, less pain.”
    
The nurses not only got trained in how to do the procedure, they compared equipment and negotiated for a state-of-the-art ultrasound machine to guide insertion of the needle. They’re also helping decide how to bill for the service.
    
The process has been eye-opening. “It’s made me learn about how much hospital equipment costs,” Misuna said. “We’re trying to put it in so it’s profitable but also reasonable.”
    
Helping to improve care is its own reward. But it will also be satisfying to be recognized through the Clinical Ladder program, Misuna said. “We’re getting a different skill and different education. It gives us a little more incentive to earn some more money.”
    
Patty Lemieux, an RN who works on the hospital’s maternity unit, agrees. During her 16 years at Shore Memorial Hospital, she’s participated in many activities that would have counted for points on the Clinical Ladder, including earning a bachelor’s and two associate’s degrees, teaching breastfeeding and newborn care classes to the public, and serving as a Neonatal Advanced Life Support instructor for hospital staff.
    
“I’m really happy about this,” Lemieux said. “I think it would benefit everybody.”
    
For seasoned nurses who participate, the Clinical Ladder would reward dedication, knowledge and seniority, Lemieux said. “The things they ask might take a little time but they’re not that hard. It will help the hospital along with helping the nurse with advancement – along with a positive outcome for the patient.”
   
Some newer nurses are just as excited. Cindy Wallop, who works in Shore Memorial Hospital’s Skilled Nursing Facility, sees the Clinical Ladder as great opportunity. She went back to school at age 35, and between working and raising four children, it took six years to graduate. She joined the hospital staff in 2004.
    
“I’m so excited,” Wallop said. “I think all nursing is good care but this opens doors where you can learn. Being on the Clinical Ladder gives everybody a chance to reach their goals. My goal is to get a bachelor’s degree.”
   
Some nurses believe Clinical Ladder will promote a healthy competition among RNs. After the ball gets rolling, no one will want to be left behind. “We all want to know things,” Misuna said. “We all want to be at the top of our game. It promotes excellence in nursing.”
    
But in the end, it all comes back to the hospital’s mission of delivering the best care, Perry said. “The goal is that we have better patient outcomes because you have more nurses out there who can help. You also have nurses with better job satisfaction because they feel like they’re part of something.”