Nursing – Clinical Ladder
At Hershey Medical Center, our Nursing Education and Professional Development program helps nurses at every level grow and flourish in their profession.
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Penn State College of Nursing
Professional Clinical Ladder
The Professional Clinical Ladder program strives to acknowledge qualities of excellence in clinical practice. The standards are based on the American Nurses Association (ANA) Standards of Professional Practice and the Pennsylvania State Board of Nursing.
Through self-assessment, direct-care nurses develop a portfolio that demonstrates their level of practice. This includes subjective and objective data that are evaluated by the peer-led committee. The application process consists of three integrated components: application portfolio, audit and interview. All three components are interrelated and complement each other to present a picture of the whole practice.
Registered nurses who attain the next step on the clinical ladder must:
- Work at an FTE of .5 or greater
- Be in the staff nurse job code and be directly involved in patient care
- Have successfully passed probation and completed orientation
- Have a minimum of two years nursing experience
- Have a degree of BSN or higher for Level IV
Domains of practice
Promotion on the professional clinical ladder is based on the demonstration of clinical expertise in the following domains:
- Domain 1: The caring role
- Domain 2: Patient and family education
- Domain 3: Clinical practice
- Domain 4: Monitoring and ensuring the quality of health care practices
- Domain 5: Professional collaboration and consultation
- Domain 6: Clinical knowledge development
Download our domain descriptions PDF.
Description of levels
Nurse Clinician I
The Nurse Clinician I is guided by policies, procedures and standards. The graduate nurse at this level is building a knowledge base through practice and is more comfortable in a task-oriented environment. Graduate nurses often describe a clinical situation from the viewpoint of what they need to do, rather than relating the context of the situation to how the patient responds. They continue to rely on the judgments of others. When complex clinical situations arise, they seek nurses with great authority. Experienced RNs entering the new employment situation have an existing foundation of knowledge and skills related to policies, procedures and standards of practice. They seek resources to affirm that their recent practice is compatible with the medical center's practice. They can demonstrate critical thinking and decision-making skills. They can clearly articulate and document patient needs and interventions. All RNs enter the system as Level I. With successful completion of probation and orientation they proceed to Level II.
Nurse Clinician II – Sound practitioner
The Nurse Clinician II is fully competent. This nurse assumes responsibility for her or his primary patients. Deliberate planning, analysis and goal setting are hallmarks at this level. This nurse recognizes relationships within patient data and bases judgments on careful consideration of this information. Nurses at this level demonstrate mastery of most technical skills, focus on organizational skills in their assigned clinical areas and are ready to learn the responsibilities of the charge nurse. They can remain at Level II indefinitely or apply for Level III or IV after six months.
Nurse Clinician III – Proficient practitioner
Nurses at this level practice with an in-depth knowledge of nursing practice based upon previous experiences. A proficient nurse has progressed from a task-oriented approach to providing nursing care with a holistic view of the patient. This nurse perceives each situation as a whole, and is able to identify the salient elements. Critical thinking is apparent and judgments are oriented toward the best possible outcome for the patient. This nurse responds to most situations with speed, confidence and flexibility, and is able to handle unanticipated problems or emergencies. He or she forms effective relationships and demonstrates leadership skills within the multidisciplinary team.
Nurse Clinician IV – Expert practitioner
Intuition and skill arise from a comprehensive knowledge base thoroughly grounded in experience. Nurses at this level have a flexible, innovative and confident self-directed approach to patient- and family-centered care. Rapidly changing and complex patient care situations challenge this nurse to reach his or her full potential. This nurse has a vision of what is possible and a keen sense of timing to make things happen. The Nurse Clinician IV is system savvy, understands the interdependence of disciplines and departments, and can finesse situations to maximize patient outcomes. This nurse functions with an ongoing healthy skepticism, questioning situations that are atypical. He or she uses ethical reasoning and has the ability to automatically filter irrelevant data. This nurse is a positive force in the advancement of professional practice and quality of patient care.