Impact of clinical clerkship integrated with clinical ladder on attending physicians' teaching self-efficacy.

BACKGROUND: Self-efficacy plays an important role in enhancing the teaching capabilities of attending physicians (APs). The clinical ladder (CL) is an educational approach developed in the field of nursing education that increases difficulty in an incremental manner. However, no previous study has confirmed the effectiveness of CL in medical education. Therefore, this study aimed to examine the effect of clinical clerkship integrated with clinical ladder (CC-CL) on the self-efficacy of APs. METHODS: Sixth-year medical students participated in CC-CL for 6 months starting from April 2023, and the changes in the self-efficacy of APs were retrospectively evaluated. The students were trained by the APs concurrently, and the achievement levels of each student were shared. The primary outcome measure was the physician teaching self-efficacy questionnaire (PTSQ) score. The PTSQ scores before and after CC-CL were analyzed using the Wilcoxon matched-pair signed-rank test. RESULTS: Fifteen APs from the Department of Pediatric and Child Neurology were included in this study. No significant difference was observed in the total PTSQ scores of the APs before and after CC-CL. However, a significant increase was observed in the PTSQ score of APs who participated for at least 2 h per week over a period of more than 3 months (n = 8) after CC-CL (p = 0.022). Furthermore, APs who had received their pediatrician certification < 10 years ago (n = 8) showed a significant increase in the total PTSQ score after CC-CL (p = 0.022). CONCLUSIONS: CC-CL may play an important role in cultivating the self-efficacy of less experienced APs. Further comparative studies must be conducted in the future to validate the findings of this study.

Leveraging Clinical Ladder Nurses to Support an Education Program on Intraoperative Cell Salvage for Obstetric Patients.

Postpartum hemorrhage continues to be a leading cause of maternal morbidity and mortality in the United States. With the use of appropriate screening tools and treatment modalities, most of these deaths are preventable. Various interventions are used to prevent and treat postpartum hemorrhage, though intraoperative cell salvage historically has been contraindicated in the obstetric setting. This article explores the implementation of intraoperative cell salvage in the obstetric setting at two campuses of a health care system with the assistance of nurses participating in a professional nurses advancement program (ie, a clinical ladder). The initiative comprised a literature review, interdisciplinary collaboration, and education planning and execution. The educational approach focused on adult learners and included both self-directed and instructor-led elements. Including clinical nurses in clinical education is beneficial because they are highly motivated to share evidence-based practice with their peers to elevate patient safety and quality measures, making them ideal education partners.

A global examination of clinical ladder programs - A synthesis of commonalities and opportunities for standardization.

BACKGROUND: Clinical ladder programs (CLPs) have been part of the nursing profession for nearly 4 decades. However, the structure and implementation of CLPs vary widely throughout healthcare systems. CLPs are a valuable factor in nurse retention and employee satisfaction initiatives, but globally replicating and measuring their impact is difficult due to lack of standardization. AIM: To identify opportunities for global standardization of CLPs through a systematic review of published evidence and facility-sourced CLPs applications and program documents. METHOD: This study used a systematic literature search and scan of existing programs from facilities within the United States (US), Lebanon, and Ghana obtained through professional ties and organizational membership. RESULTS: Seventy-nine articles were screened with 30 studies identified for inclusion, plus 20 CLPs from the US and international facilities. Identified commonalities were the lack of consistency in the number of clinical levels across the CLPs, eligibility requirements and application process, reward and recognition, lack of emphasis on technology and informatics, and missed opportunities to use CLPs to drive a culture of safety. The administrative burden of the programs and the time required by the nurse to complete the CLP application were rarely referenced. LINKING EVIDENCE TO ACTION: The lack of consistency between facilities and across the healthcare sectors limits the measurable impact CLPs have on the nursing profession. Recommendations for practice include developing a standardized professional development framework. A standardized framework will encourage adoption of a retention tool that will provide the profession with a measurable method to demonstrate the value it brings to patient care. Providing guidance to health care facilities in low- and middle-income countries on the implementation of a professional development framework will assist in closing the global gap of professional development opportunities for nurses.

The Effects of Pain, Agitation, Delirium, Immobility, and Sleep Disruption Education on Novice Nurses in Adult Intensive Care Units.

Intensive care unit (ICU) patients experience highly complex health problems, such as pain, agitation, delirium, immobility, and sleep disruption (PADIS), and require professional nursing care. The assessment of PADIS is critically important for ICU nurses, and therefore, PADIS education programs need to be conducted for these nurses to update and improve their caring knowledge, attitudes, and skills. The aims of this study are to bridge this gap by evaluating the effects of PADIS education programs on the knowledge, attitudes, and skills of these nurses, and compare the difference between novice and advanced nurses after receiving the PADIS education programs over a short period of time. In this quasi-experimental study, 112 nurses in ICUs were recruited by researchers and participated in the PADIS education programs. The PADIS education intervention was performed in a teaching hospital in Taipei. A demographic and self-developed PADIS care knowledge questionnaire was used. A baseline (T1) was measured before the interventions, followed by post-test (T2) immediately after the programs, and subsequently a follow-up (T3) test one month later. The results indicated that knowledge and skill scores between novice and advanced nurses varied significantly in T1 but not in T2 and T3. Thus, education programs can significantly assist novice ICU nurses to improve their short-term knowledge, attitudes, and skills, and PADIS education programs are strongly suggested for clinical nursing practice.

Relationships between Willingness to Participate in the Nursing Clinical Ladder Program and Its Related Factors among Clinical Nurses.

The professional nursing competence ladder system can effectively inspire nurses' work morale, improve quality of life, and avoid the issue of senior staff leaving the clinical setting. The aim of this study was to explore the willingness to participate in the professional nursing competence ladder system and its related factors among nurses. A cross-sectional study design with a structured questionnaire was used. Purposive sampling was employed, and 696 nurses who qualified to be promoted as N2 were recruited from a medical center in southern Taiwan. The results showed most nurses were willing to participate in the nursing ladder system. There were significant differences between willingness to participate in the ladder system and age, education level, as well as promotion experience. This study emphasizes the importance of intensifying internal encouraging factors and strengthening external encouraging factors to improve participation rates. Healthcare institutions could provide instruction on case report writing to increase nurses' willingness to participate in the clinical ladder program.

Supporting Advanced Practice Providers Through the Development and Implementation of an Advanced Practice Provider Professional Advancement Program.

As the number of Advanced Practice Providers (APPs) has increased across health care settings, institutions have identified the need to provide opportunities for the advancement, growth, and development of APPs. An APP Professional Advancement Program was developed and implemented at our freestanding, pediatric academic medical center that employs over 700 APPs. This program was designed to support all APPs regardless of their role and practice setting by recognizing their accomplishments and providing the tools and resources needed to pursue opportunities to further their professional development and leadership. This article describes the development, implementation, and sustainment of an APP Professional Advancement Program.

Operating Room Nurses Want Differentiated Education for Perioperative Competencies-Based on the Clinical Ladder.

Operating room (OR) nurses' perioperative competence is vital in operation and patient care. This cross-sectional descriptive study aimed to identify perioperative competencies and educational needs for improving competencies according to the clinical ladder. A total of 318 OR nurses in Korean tertiary hospitals were recruited. Data from the self-reported questionnaire of perioperative competencies, measured on a five-point Likert scale, were used. The average score of perioperative competence was 3.78 ± 0.54; among the sub-categories of competencies were collaboration (4.08 ± 0.55), foundational knowledge and skills (3.98 ± 0.56), proficiency (3.87 ± 0.64), empathy (3.77 ± 0.77), professional development (3.65 ± 0.64), and leadership (3.34 ± 0.89). There were significant differences in perioperative competencies according to the clinical ladder as follows: foundational knowledge and skills (p < 0.001), leadership (p < 0.001), collaboration (p = 0.017), proficiency (p < 0.001), and professional development (p < 0.001). The educational needs for foundational knowledge and skills (4.43 ± 0.60) were highest, and educational needs for proficiency (4.26 ± 0.70), collaboration (4.21 ± 0.77), leadership (4.08 ± 0.81), empathy (3.99 ± 0.91), and professional development (3.91 ± 0.76) were noted. The educational needs for improving perioperative competencies by clinical ladder showed a significant difference in leadership (p = 0.026), proficiency (p = 0.045), and professional development (p = 0.002). In order to develop an effective education program for OR nurses, differentiated education designs that reflect perioperative competencies and educational needs per clinical ladder are necessary.

Turning a Crisis Into an Opportunity: Promoting Professional Development Among Perioperative Personnel During a Pandemic.

The perioperative setting is a complex, high-risk working environment. Ensuring adequate staffing with highly competent nurses remains a top priority to sustain safe patient care. However, there are barriers to individual professional advancement in hospitals, including costs and lack of support or time, which can lead to decreased nurse satisfaction. After the mandated cancellation of elective surgery in March 2020 resulting from the coronavirus disease 2019 pandemic, leaders at a medical center decided to turn this difficult situation into an opportunity to re-engage their perioperative personnel in professional development. More than 70 staff members participated in activities related to certification, continuing education, clinical advancement, and cross-training. Elective surgery has since resumed, and as a result of the pursuit of professional development opportunities, staff member turnover did not increase throughout the transition at the medical center. Interest in professional growth has been reignited and staff members are excited about future development opportunities.

The Implementation of a Clinical Ladder in Rural Japanese Nursing Education: Effectiveness and Challenges.

The clinical ladder is an essential tool for nursing education, enabling nurses to ascend from novice to expert. The learning content for nurses can depend on their clinical situations. The aging of societies has changed the demand for nurses at community hospitals because of the multimorbidity of older patients. At the same time, the gap in nursing education between urban and rural hospitals is wide, as rural hospitals often lack the application of the clinical ladder. This study investigates the effectiveness of using the clinical ladder in a rural Japanese community hospital using the clinical ladder scale and interviews. Through its application, we found that both novice nurses and nursing educators came to recognize the effectiveness and importance of the ladder. However, unfamiliarity with assessments, working conditions, and Japanese culture inhibited the smooth application of the ladder. For the effective application of the clinical ladder, continual training on assessments and the ladder's effectiveness in clinical situations, along with consideration of educational background, should be enhanced through the monitoring of the clinical ladder.

Development of a Competency Scale for Nurses of a Japanese Community Hospital: The Unnan Ladder.

BACKGROUND AND PURPOSE: The Japanese Nurse Association (JNA) has established the JNA ladder to assess competency in various clinical nursing settings in Japan. This study developed and tested a specific Japanese community hospital's Nurse Competency Scale (the Unnan ladder). METHODS: Using the Delphi method, the contents of the Unnan ladder were identified and validated in a four-step approach. A 28-nurse panel approved 66 items; 112 community nurses assessed the content, construct concurrent validity, and internal consistency of the Unnan ladder competency scale. RESULTS: The Unnan ladder data were normally distributed. Higher scores on it correlated with higher scores on the Nurse Competency Scale. The Unnan ladder categories showed good internal consistency. CONCLUSIONS: This ladder's application may lead to improved nursing skills and better patient care.

Attributes of a Successful Clinical Ladder Program for Nurses: An Integrative Review.

BACKGROUND: Clinical ladder programs (CLPs) are often utilized by healthcare organizations to monitor and incentivize staff nurse development. Few studies exist related to this topic, yet implementation of CLPs can be an important factor in staff nurse retention and satisfaction, and therefore requires better understanding. AIM: To identify and examine the factors that contribute to a successful CLP. METHODS: A systematic search of the literature was conducted in PubMed and CINAHL. Studies were not limited by year and were included if the focus was CLP attributes. PRISMA and PICOT were used to guide the process. A matrix of the existing studies was used, and interrater reliability was established at 90% with consensus building for inclusion of studies by the research team. RESULTS: Twenty-nine studies were identified for inclusion. Most were program evaluation. Institution's organizational culture was identified as the overarching attribute contributing to a successful CLP. Common themes identified as important to a supportive organizational culture were (a) education and experience; (b) competence and critical thinking; (c) job satisfaction and retention; and (d) compensation and institutional cost. Each of these components can play a significant role in the overall success of a CLP. LINKING EVIDENCE TO ACTION: While further research of a higher caliber is needed, some recommendations for practice can be made: (a) CLP description and terminology needs to be consistent with intent, (b) mandatory CLP engagement has positive implications, and (c) implementation needs to be driven by bedside nurses and includes both continuous education and refinement of program requirements and incentives.

[Project to Increase the Percentage of Nursing Staffs Passing Clinical Ladder-3 Certification in the Intensive Care Unit].

BACKGROUND & PROBLEMS: Clinical ladder (CL)-3 nurses should have both an ability to integrate the clinical information of critically ill patients and to carry out the administrative work of the intensive care unit. However, in our unit, only 15.3% of nurses hold CL-3 certification, which is much lower than the hospital average of 23.1%. Thus, we initiated a project to raise this percentage in our unit. An analysis in January 2016 showed that the main obstacles to obtaining CL-3 certification in our unit were inability to write case reports, inadequate in-service education, and a lack of certified educators. PURPOSE: The purpose of this project was to increase the number of CL-3-certified nurses in our intensive care unit. RESOLUTION: The resolution included holding courses on case report writing, briefings, and oral presentation techniques; assigning a preceptor to make nursing staff assignments; encouraging nurses to participate in the clinical nursing preceptor education training camp; and conducting practice tests using a multiple assessment tool. RESULTS: After implementation of this project, the percentage of unit nurses who had passed CL-3 increased to 39.0%. CONCLUSIONS: This project not only allowed our fellow nurses to share in the joy of clinical ladder advancement but also improved the atmosphere in the unit by encouraging self-development. This project helped stimulate professional growth among our staff and improved the quality of clinical care.

Development, Implementation, and Satisfaction With a Nurse Practitioner Professional Ladder: A Children's Hospital Experience.

This article describes the development and implementation of a nurse practitioner professional ladder (NPPL) at a large freestanding urban pediatric hospital. The NPPL was created to recognize advanced practice registered nurses and differentiate levels of clinical expertise, role development, leadership, and professional contributions into a three-tiered approach, designated as NP I, NP II, and NP III. The results of a nurse practitioner satisfaction survey at Year 2 and Year 4 after the development of the NPPL are summarized. The NPPL helped create an empowering environment for continued nurse practitioner professional growth.

Revised Clinical Ladder System Model Based on Nurses' Clinical Competence and Professional Activities for Nurses in General Hospitals / 임상간호연구

PURPOSE: The purpose of this study was to propose a revised Clinical Ladder System(CLS) Model for nurses based on the evaluation of clinical competence and professional activities of nurses working in general hospitals. METHODS: Data were collected between September 10 and October 30, 2017. Participants were 50 head nurses from 10 general hospitals with over 400 beds located in Seoul City and Gyeonggi Province. Each head nurse evaluated clinical competence, qualifications, and professional activities of 5 staff nurses at each of the 5 levels of CLS in her unit. The total number of the nurses evaluated was 245. Data were analyzed with descriptive statistics and t-test, one-way ANOVA, and Scheffé. RESULTS: Over 80% of the nurses were university graduates. As the CLS levels increased, clinical competence, qualifications, and professional activities also increased significantly. Education material development and quality improvement activities were carried out by nurses from level 2, research and evidence based practice activities were carried out from level 3, and nurses at level 4 or 5 participated in most of the professional activities as leaders. CONCLUSION: In order to retain excellent nurses in general hospitals, recognizing and rewarding nurses according to the revised model of the CLS are recommended.

The Future of Respiratory Care: Results of a New York State Survey of Respiratory Therapists.

BACKGROUND: In the current health-care environment, respiratory care may need to make significant changes to academic preparation and clinical practice. The purpose of this research was to assess current needs of respiratory therapists (RTs) in New York State and to understand how RTs perceive their future clinical and academic roles. METHODS: This study employed a descriptive, cross-sectional non-experimental design. Between October and December 2014, a 32-item online survey was distributed via e-mail to the 2,170 members of the New York State Society of Respiratory Care. Descriptive statistics were used to summarize responses, and bivariate analyses were assessed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The response rate was 22% and resulted in 435 valid surveys returned. Seventy percent of 415 respondents agreed that the practice of respiratory care is at risk of losing practitioners. The most important incentive for retention of practitioners in the field was professional growth and an expanded scope of clinical practice. Specifically, the most important of these roles was gaining the ability to assess patients, develop a plan of care, and receive reimbursement for services. Sixty-four percent of 415 respondents strongly agreed that the minimum academic standard for RTs should be raised to the baccalaureate level. Of 415 respondents, the majority (78%) agreed that it is important for therapists to remain in the profession and to be an active member of the American Association for Respiratory Care (83%). CONCLUSIONS: These data are useful to the profession, notably for academic programs that must meet the need for a more highly prepared and skilled workforce. The findings emphasize that viability of the profession in the current health-care environment calls for the evolution of a more autonomous RT who can be reimbursed for services and obtain salaries that are competitive with other health professions.

Validity and Applicability of Clinical Ladder System Model for Nurses / 임상간호연구

PURPOSE: The purpose of this study was to verify the validity and applicability of the Clinical Ladder System(CLS) Model for nurses and to suggest a model for nurses in general hospitals as well as tertiary hospitals. METHODS: After refining questionnaires through focus group participation, a survey was carried out with 50 nurse managers and 500 staff nurses from 6 tertiary hospitals and 4 general hospitals. S-CVI and i-CVI for validity and applicability were calculated. Differences in validity and applicability by the type of hospitals and characteristics of respondents were analyzed using t-test and ANOVA. RESULTS: S-CVI for validity and applicability of the CLS model were over 0.8 in two types of hospitals and the validity and applicability of the CLS model were confirmed. No differences were found in the total score for validity between the 2 types of hospitals, but in applicability, general hospitals had significantly lower applicability than tertiary hospitals. Some items showed difference according to characteristics of the respondents. CLS models were postulated based on the study results. CONCLUSION: The CLS model refined through this study can be used for nurses. In application, modifications are needed according to the conditions of each hospital.

[Review and analysis of the review results of Taiwan nurses association nursing projects (2011~2013)].

BACKGROUND: Nursing projects are a key part of N4 professional competency training for nursing personnel. Low passage rates for these projects have been shown to negatively affect the intent of nursing personnel to advance further in the nursing ladder system. PURPOSE: This study analyzes the scores for nursing projects between 2011 and 2013, the passage rate for these projects, and the differences in passage rates between different types of projects. METHOD: This retrospective and descriptive study collected data on nursing projects conducted under the auspices of the Taiwan Nurses Association between 2011 and 2013. Furthermore, the comments of reviewers on 100 nursing projects were randomly selected and subjected to content analysis. RESULTS: A total of 3,359 nursing projects were examined. Eliminating unqualified nursing projects left a total of 3,246 projects for the dataset. A total of 1,099 projects were scored with passing grades, giving a passing rate of 33.9%. The authors of these passing projects worked primarily in northern Taiwan, worked in medical centers, and worked in intensive care departments. The projects submitted by authors in central Taiwan had the highest average score and passing rate, while those living in offshore islands had the lowest average score and passing rate. Most of the project topics belonged to the category: "improvement of nursing service skills or quality" (77.3%). Items with the lowest scores were: validation of questions, analysis of the current situation, and evaluation of results. The topics of nursing projects did not relate significantly to passing rate. However, years of experience, geographic location of hospital, level of institution, and department each had a statistically significant impact on the passage rate. A content analysis of reviewer comments was used to extract common problems. Most of the positive comments were related to the category of "literature review and reference", while most of the negative comments were related to the categories of "literature review and reference", "analysis of current situation", "problem result and process", "evaluation of results", and "validation of questions". CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study analyzed the types of nursing projects, the trends in submission, and the comments of project reviewers. The results indicate that the validation of problems in project writing and current situation analysis and the evaluation of results should be improved. These findings may be referenced by nursing personnel for executing projects in the future and for developing improved criteria / methodologies for the clinical ladder system for nursing personnel.

Implementation of evidence-based practice in relation to a clinical nursing ladder system: a national survey in Taiwan.

BACKGROUND: Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. METHODS: A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. RESULTS: Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. LINKING EVIDENCE TO ACTION: The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation.

Effect of Perception of Career Ladder System on Job Satisfaction, Intention to Leave among Perioperative Nurses / 간호행정학회지

PURPOSE: This was a correlational study to identify effects of perception of clinical ladder system on job satisfaction and intention to leave in perioperative nurses. METHODS: Participants were 154 of perioperative nurses from larger general hospitals in Seoul. Data were collected from April, 16 to 22, 2013 using self-report questionnaires which included items on perception of clinical ladder system, job satisfaction, and intention to leave. Data were analyzed using frequency, t-test, ANOVA, Scheffe? test, Pearson correlation coefficients, and multiple stepwise regression. RESULTS: The average mean score for perception of clinical ladder system was midline at 2.69 point out of 4 point. Perception of clinical ladder system correlated positively with job satisfaction (r=.38, p<.01) and negatively with intention to leave (r=-.88, p<.01). Perception of clinical ladder system was the factor which most influenced job satisfaction explaining 17.1% of the variance, also perception of clinical ladder system was the factor which most influenced intention to leave, explaining 12.7% of the variance. CONCLUSION: Results of this study suggest that there is a need to enhance the perception of the clinical ladder system and to find ways to fulfill the expected effects for improving perioperative nurses' job satisfaction and reducing the intention to leave.