PEN Clinical Advancement Model

By Jayne Gmeiner, MS, RN, NEA-BC

The current ACE (advancing clinical excellence) clinical advancement ladder for registered nurses, implemented at AMC, GSH, and MVH was initiated in the mid-2000s. The focus of the program was to recognize the ACE participant and their clinical performance, utilizing individual nurse professional goal attainment and active committee participation as measures of success. Clinical advancement programs are recognized nationally in the literature as key recruitment and retention programs. In addition, clinical advancement programs can result in an engaged clinical nurse workforce, and can be linked to clinical performance improvement, lower vacancy rates, and success with retention of experienced clinical nurses.

In evaluation of opportunities to improve the current ACE program, the development team performed an evaluation of the evidence, as well as a review of Magnet hospital clinical ladder programs, and recognized opportunities to enhance, revise, and revisit the existing clinical advancement program. UVMC utilized a different model of the clinical advancement program, the goal of which was to develop a unified Premier Health program that directly aligned with the strategic priorities of the organization, including exemplary professional practice; patient experience; and professional development of the clinical nurse.   The current ACE model is linked to individual performance outcomes, including professional certification and/or BSN degree attainment, membership of professional organization, participation in peer review, and the completion of a written exemplar describing a practice situation.

Clinical nurse participation to guide the group during redesign was critical to the team.  Premier committee members participating on this redesign team include: 

  • Jayne Gmeiner, MVH, Chair
  • Sheila Leis, MVH
  • Patti Schairbaum, MVH
  • Kim Porter, MVHS
  • Leslie Helmbrecht, HR
  • Lisa Drees, HR
  • Shelly Franz, HR
  • Brittney Snider, AMC
  • Christie Gray, AMC
  • Julia Ralston, GSH
  • PJ Musser, GSH
  • Pam Phelps, GSH
  • Jean Heath, UVMC
  • Brenda Miller, UVMC
  • Yolanda Munguia, UVMC

The Premier clinical ladder team performed an assessment of current career ladder, and utilized clinical nurse team members on the design to assist with assessment and revisions.  In addition, the team conducted focus groups with nursing leaders to gain feedback of key important characteristics of a successful clinical advancement program. Dr. Syl Trepanier, Premier Health System CNO, and Premier Health CNO council provided direction in regards to definitions of exemplary professional practice outcomes, with the goal of aligning the clinical advancement program to the Magnet model.  Key differences in model are described below:

Current ACE Model
(Currently at Atrium, GSH, MVH; implemented in 2005)
New Premier Excellence In Nursing Model (PEN)

  • Designed on Benner’s Theory of novice to expert
  • System designed in four levels with entry level being Level I and monetary award at Level II (.50) III (.75), and Level IV ($1.00). * Added as ACE Diff on base worked hours.
  • Does not include organizational clinical/patient experience outcome measures
  • Required Individual RN to provide the following for highest Level:
    • Requires NM approval for participation through form “sign-off.”
    • Evidence of professional certification and/or BSN or MS/MSN attainment
    • Evidence of professional organization membership
    • Completion of exemplar writing
    • Participation with peer review feedback

  • Designed based on  Benner’s Theory of novice to expert and ANCC Magnet model
  • Designed to align with Premier strategic plan outcome goals/quality scorecard, value-based performance excellence, and positive work environment.
  • System designed in 8 tiers, with entry level being finalized at this time; propose entry level requiring 5 points.
  • One point must be achieved in each column of the PEN grid.
    • One entire PEN grid column dedicated to quality; clinical; LOS; readmission; and work environment outcomes (exemplary professional practice).
  • three columns on PEN grid dedicated to individual contribution, with prescriptive forms describing point attainment process.  

The leadership team at Premier Health believes that the development of the professional nurse is critical to the practice of clinical nursing.  The clinical ladder program provides a forum to recognize professionalism and expertise offered in direct patient care delivery.  The proposed new program will be titled “Premier Excellence in Nursing” (PEN). The PEN program provides an environment to positively impact patient outcomes and promotes a high standard of patient care.  The PEN program is a pathway for RNs at Premier who choose to advance and grow within the clinical setting.  It is built on the characteristics and qualities identified in Patricia Benner’s “novice to expert” theory of nursing development, beginning with the novice nurse and transitioning to the expert nurse. This program is also designed with the four key ANCC Magnet recognition program components of exemplary professional practice; transformation leadership; structural empowerment; and new knowledge and innovation, as well as system goals for value-based performance.  

The clinical ladder program was developed by, and for, RNs throughout Premier.  The program is congruent with Premier’s standards of respect, integrity, compassion, and excellence, as well as our pillars of success:

  1. Positive work environment
  2. Patient experience and quality
  3. Physician partnership
  4. Competitive positioning and financials

This program has four overall objectives for RNs providing patient care.  They are to:

  • Create an environment which promotes high quality patient care;
  • Provide recognition and reward associated with level of clinical expertise;
  • Attract and retain highly skilled RNs;
  • Provide a network of resources for clinical expertise, collaboration, and consultation. 

Eligibility Requirements for Participation in Clinical Ladder

The candidate must meet all of the following criteria to be eligible to participate in the clinical ladder program:

  • Must currently be an employed RN in a permanent hourly position (FT, PT, support), providing direct patient care;  
  • Eligible position descriptions must be 100% clinical, with no managerial responsibilities (e.g., coaching/disciplinary or performance evaluation of personnel);
  • Eligible candidates with continuous service may transfer clinical ladder tier between Premier organizations;
  • Eligible position descriptions must include all components of the nursing process (assessment, planning, implementation, delegation, and evaluation);
  • Nursing team leaders/charge nurses are also eligible;
  • Candidate must have had six consecutive months of employment with Premier as a registered nurse at application date.
  • Candidate must have received at least an “achieves” rating on their last performance review; 
  • Candidates will not be eligible for clinical ladder at level of corrective action (step three—“written warning”) where organizational consequences take place;
  • Candidate must have been an RN for two years or more at application date.

All information for the PEN clinical advancement program will be available on HealthStream.  Please look for future communication and open meetings to continue to educate our nursing team on this innovative model to recognize clinical expertise and provide integration with our overall Premier strategic and Premier nursing strategic plan.

<< Back to the February 2014 Issue

Source: Jayne Gmeiner, MS, RN, NEA-BC

Content Updated: February 20, 2014

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