1. Robitaille, Debbie RN, OCN, MSN
  2. Whelchel, Catherine RN, MHSA

Article Content

Nurse leaders at Spartanburg Regional Healthcare System (SRHS), Spartanburg, S.C., have an innovative approach to recognize and reward experienced nurses. We revitalized our old clinical ladder in a unique manner. Through a staff contest, we named the program Nursing PRIDE (Professional Recognition in the Development of Nursing Excellence). The tool truly meets its mission of fostering an environment of clinical excellence to promote positive patient outcomes, and it makes a difference at recruitment time. Hopefully, the ultimate satisfaction for any nurse is knowing that he or she provided the best care possible for the patient.


Steps to success

SRHS's nurse advisory board-composed of staff nurses from various specialty areas-led the project, in collaboration with the previous clinical ladder committee. The priority for the board's project was nurse retention and quality. The planning and development phases for Nursing PRIDE included:


[white diamond suit] performing a staff survey for input


[white diamond suit] including the clinical ladder committee in the planning process


[white diamond suit] setting inclusion criteria for the new program


[white diamond suit] brainstorming ideas that demonstrated clinical excellence or professional development


[white diamond suit] enlisting the assistance of a statistician to provide scoring


[white diamond suit] seeking system support for financial reward and recognition


[white diamond suit] developing a transition plan for those currently in the clinical ladder program.



Next came the implementation phase, which included:


[white diamond suit] opening education sessions and disseminating the tool to every RN


[white diamond suit] educating patient care services leadership


[white diamond suit] amending performance appraisal tools


[white diamond suit] implementing an evaluation process at the program's 1-year anniversary.



The staff survey indicated that the clinical ladder was no longer a true retention tool. We wanted a successful program, but one that didn't devalue staff if they couldn't accept added responsibilities over the annual time period. We also wanted a true reward and recognition process for RNs that go the extra mile.


Climbing higher

We timed the new retention tool to coincide with the annual performance appraisal process. Staff members maintained their own records for this evaluation process. Each nurse who met the criteria received not only financial reward, but system recognition.


We developed a transition plan to avoid two separate clinical ladder programs for those enrolled in the original process. Setting this pathway before the rollout of the project was key to the satisfaction of nurses using the previous system, and to the new tool's success and effectiveness. Nurses had the option to attend question-and-answer sessions to fully understand the PRIDE program.


Criteria for point accumulation included the latest performance appraisal scores, hourly pay, and full-time status. Areas in which nurses could accumulate points included education, professionalism, clinical excellence, committee involvement, and more.


In 2001, 11% of the nursing staff participated in the clinical ladder program. With the advent of PRIDE, participation increased to 30% in its first year. The first payout was $550,000, which SRHS administrators considered an investment in excellence. It's difficult to quantify the effects of improved precepting of new grads, less unit turnover, and better patient care. But some differences have been measurable, for example, the number of certified nurses tripled on one specialty unit; our patient satisfaction scores have broken all historical records; and more nurses have been hired since the program's inception than at any previous time on record.


There are some changes we've made in the process since its 1-year anniversary. We added caps to several point accumulation categories, amended some of our weighting, and made a few other small alterations.


By and large, this framework provides a structure for long-term success.