Empowering Direct Care Nurses to Create a Culture of Safety Through the Clinical Ladder Advancement Process

Purpose:
Nursing leadership at Northwestern Lake Forest Hospital created an innovative clinical ladder with the goal of fostering retention and enhancing professional development by recognizing nurses for their involvement in creating a culture of safety on their units.

Significance:
Empowering nurses through a clinical ladder program allows them to identify and develop patient safety initiatives to create a culture of safety on their units. Staff involvement promotes retention, recognition and professional development.

Strategy and Implementation:
Using Patricia Benner's Novice to Expert framework, ANA Standards, and the Relationship-Based Care Model, an innovative clinical ladder was created to empower staff nurses to enhance a culture of safety on their units. Nurses are required to develop, implement and evaluate an evidence based project to improve care of patients on their unit. In addition, professional activity points are earned through involvement in multiple activites. Members of the advanced practice nursing council critique and accept candidates into the program and serve as mentors for the staff nurses to assist them with navigating the complexities of effecting change within the hospital. Upon successful completion of the ladder program, the nurses disseminate their exemplary work to the members of our shared governance council receiving recognition and inspiring others to take a step on our ladder. Nurses are congratulated on the unit level and awarded a monetary bonus.

Evaluation:
Forty-two staff nurses have participated in the ladder program to date. Seventeen patient safety initiatives have been completed in 13 inpatient and outpatient areas. Bonus compensation awards equal $85,000. Nurse turnover decreased from 24% to 8.3% since ladder program inception.

Implications for Practice:
Examples of projects developed by staff nurses to enhance patient safety include: • Increasing Safety of Patients Undergoing Moderate Sedation • Triage Re-Design in the ED • Development of Hypothermia Protocol • Medication Safety Zones • Patient Positioning in the OR to Reduce Complications