Clinical Nurse Ladder

Hospital for Special Surgery (HSS), a Magnet Designated and number one nationally ranked orthopedic hospital, sought to provide additional opportunities for nursing growth and advancement. The Capstone team was charged with incorporating evidenced-based practices into HSS’s Clinical Nurse Ladder (CNL) in order to improve the robustness of the system. The team conducted interviews with nurse leaders, carried out surveys to gain perspective from current nurses, evaluated each rung’s (or ladder) job description and remuneration, studied the CNL application process, and examined three other CNLs: New York Presbyterian-Columbia Hospital, Memorial Sloan-Kettering Hospital, and the University of Colorado Hospital. As a result, the team identified the elements of the current and an alternative ladder that were effective/ineffective, and recommended generic but characteristically distinguishable job descriptions for each rung. The team also advised on the role of managers, professional development, and learning in advancing nurses.