Career ladders in nursing – How can you move your career forward?

Week 4.1 to 4.6 (1)
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You have studied and worked hard to obtain your nursing license now you have your first job interview and already are being asked what are your goals?  Have you thought about certifications?  Where do you see yourself in two to five years’ time?  This is not unusual; organizations typically ask clinical, career ladder questions in hiring interviews.  This is the time you will hear information about the organization’s career ladder program since many organizations have some process in place for clinical advancement.  Whether you want to advance yourself professionally or not, the expectation in the 21st century of healthcare delivery requires one to pursue further education, learn about best practices to improve patient care and outcomes.  There are many benefits to a clinical ladder program including overall job satisfaction, increased nurse retention, decreased turnover, and cost savings. But more importantly, you are participating in transforming care at the bedside and empowering yourself at the same time. 

Asking the questions

By now you must be thinking why should I bother?  How do I get started?  How do I know the time is right?  Where do I get the information?  What are the requirements? How can I move my career forward and who can guide me? Are nurses in the organization pursuing such advancement, if so what are the barriers and challenges?  Some nurses shy away from clinical advancement and are contented to just work in their practice areas.  Others may not know how to get started. 

Self-assessment is the first step to success

Explore your motivation, abilities, and your behavior in relation to change.

  1. What do you want? 
  2. Are you bored, challenged, motivated?
  3. What drives you, what influences you, what is your passion?
  4. How are you going to get there?
  5. What is your work, personal/family, home commitment?
  6. What is the course, education, project, or committee expectations?
  7. What are the barriers? (financial, personal, professional)
  8. What are the pros and cons (make a list and address each one)
  9. Make a weekly calendar – daily commitment
  10. Find time every day to devote to your new professional adventure.

Talk to peers, others who have already started the journey, taking courses to improve themselves, move up the ladder, are in the process, or have finished.  Ask questions and solicit their advice.  It is amazing how hearing one person’s story about advancing professionally motivates, influences, and inspires you thoughts forming that perhaps you can do it too.  If pursuing higher education, call around to potential colleges and universities to gather information (costs, time, and commitment) on the courses/program of your interest so you can make an informed decision, narrow it down to which one is best-suited to you. 

How to get started

There are many ways to get started whether you are a new nurse or seasoned and realize it is time to take on new challenges.  Take “baby steps,” one step at a time, one day at a time. Start by reading journal articles to improve your knowledge until you are able to start taking courses.  Before you know it you have gone from I can’t do this to maybe I can.  In my early nursing years I looked up diagnoses, treatment, or anything that I was unfamiliar with in my daily practice that added to my repertoire of knowledge.  This is a habit that has continued over the years.  

Participate in unit based committees for example, education committee, quality improvement (QI), audit charts, updating policies and procedures, or volunteer to be a preceptor/mentor to new hires, student nurses.  Being a preceptor provides many opportunities to explain what you are doing and why.  You get to test and practice your knowledge, experience, and critical thinking.  For those of us seasoned nurses we practice our craft without even thinking about it.  You begin to dig deeper for the answers instead of just performing your daily nursing tasks and care by rote.

If your passion lies in quality improvement, you can participate in the inpatient quality reporting core measures such as pneumonia, sepsis, heart failure, CLABSI, CAUTI, C-Difficile.  For outpatient the quality core measures include pain, ED Throughput, stroke, chest pain, acute myocardial infarction (AMI).  If this does not interest you, look around your unit see what patient care improvements, QI, or project that may be beneficial to your unit team that you can get started on.  Talk to your manager. 

For the clinical ladder program, talk to the educator or Coordinator.  Verbalize your intentions, goals and seek guidance on how to complete the steps.  There are specific requirements in the application process to achieving each step of the clinical ladder along with financial incentives.  Remember, annual skills and ongoing competencies are standard regulatory requirement to validate and maintain our knowledge, skills, and abilities as responsible accountable nurses. 

Clinical advancement empowers us with new knowledge which makes us clinically stronger and provides more opportunities for career advancement.  Find out what your passion is, what interests you and follow the roadmap.  If there is none then develop your own.  Be curious and empowered to ask the right questions.  There are many choices available; it is just a matter of exploring the opportunities and making a decision about what is best for you personally and professionally.  As licensed professionals we must continue to grow, learn, and improve our critical thinking skills and practice. We must commit to and embrace lifelong learning as the best strategy to improving practice, quality of care, safety, and outcomes.  Take a chance and believe in yourself, own it.  YOU are your best advocate.  Follow your heart and live your dream!

By Dr. Reezena H. Malaska, DNP, MSN, RN, CCRN
Critical Care Educator, Author, Mentor, Coach
March 26, 2019

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