Document Type

DNP Project


School of Nursing

Date of Degree

Fall 2023


Doctor of Nursing Practice (DNP)

Primary Advisor

Richard Ricciardi, PhD, CRNP, FAANP, FAAN


Nursing Workforce; Clinical ladder program


Background: The surge of nurses leaving the profession has increased in recent years raising concerns that unless systemwide changes are implemented this trend will increase exponentially for years to come. Healthcare organizations struggle to retain an experienced, competent nursing workforce and seek ways to keep them from leaving. A clinical ladder program is one potential method being implemented in which healthcare organizations mitigate the exodus of nurses and create a healthier work environment.

Objectives: This doctoral project aimed to measure the perceptions of how well a revised clinical ladder program influenced the nursing workforce satisfaction in the following areas: clinical competence and performance, accountability, professional growth, rewards and benefits, job satisfaction and engagement, and autonomy and decision making.

Methods: A descriptive study was used for this project. All participants of the study site’s clinical ladder program were surveyed regarding how well the revised program addressed the content areas. A modified clinical ladder assessment tool was used to create three surveys distributed and responses received over a 15-week study period. Results were analyzed for impact on the stated objectives.

Results: The overall grand mean for all three surveys was 3.05 (SD = 0.72). Clinical Performance rated highest (3.56, SD = 0.74) and Rewards and Benefits rated lowest (2.50, SD = 0.96). Total scores (F(2, 155) = 0.126, p = .88) and subscores (F(9.89, 766.56) = 0.528, p = .87) did not change over time. Clinical Nurse III participants reported a higher total mean score of 3.28 (95% CI (3.11, 3.45) than Clinical Nurse II participants. Differences between time intervals and participants’ program tracks were not statistically significant.

Conclusion: Survey respondents rated the study site’s current nursing clinical ladder program a 3.05 on a five-point scale. Results indicated that the overall general evaluation of the program did not improve or worsen across the three survey waves; however, Clinical Nurse III participants generally rated the clinical ladder program more favorably. Responses did not vary based on participant’s program track.

Open Access


Included in

Nursing Commons



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