1. Robinson, Karen MSN, RN
  2. Eck, Carol MBA, RN
  3. Keck, Becky MSN, RN
  4. Wells, Nancy DNSc, RN


Professional practice programs are designed to attract, retain, and reward nurses. This three-part series will describe Vanderbilt's performance-based career advancement system, the Vanderbilt Professional Nursing Practice Program (VPNPP). Part 1 outlines the overall program's foundation, philosophical background, and basic structure. The VPNPP is built upon Benner's work, distinguishing among four levels of practice: novice, competent, proficient, and expert. Work by many in the organization identified the expected behaviors for nurses at each level, which were then used to develop clear process evaluation criteria. Part 2 will examine the performance measurement and evaluation system created to support the program. The process of advancing within the program will be described in part 3.


Facing the challenges of the growing nursing shortage in a rapidly evolving healthcare environment, a group of nursing leaders from a large academic medical center formed a steering committee in the spring of 1997 to revamp the clinical ladder program. The goal was much broader than merely revising an existing program in which nurses had expressed dissatisfaction. We wanted to change the culture of nursing by defining professional nursing practice in a way that supported the growth of nurses in their careers and stimulated a satisfying environment in which to practice. At the core of this desire was the belief that a happier, more effective workforce would ultimately have a positive impact on the quality of care provided. We wanted to create a program that would be dynamic and responsive to changes in the internal and external healthcare environment, as well as promote the success of the individual practitioner and the broader organization.


The work resulted in a four-tiered performance-based career advancement system that recognizes and rewards the professional growth and application of clinical nursing expertise. The program also allows the recognition of "above the standard" performance of each nurse, whether he or she is beginning a career in nursing or functioning at the advanced levels of practice.