A clinical ladder program based on Carper's Fundamental Patterns of Knowing In Nursing

Clinical and career ladders were popular recruitment and retention initiatives in the 1980s and continue to exist in some form in many health care organizations. Despite the paucity of formal evaluations of these programs, it is assumed that programs continue to exist. From a professional perspective, one of the longstanding concerns in nursing has been the lack of advancement opportunities available to registered nurses who wish to remain in a direct care role. The introduction of clinical ladder programs allow direct care providers the opportunity to advance professionally without sacrificing the direct care role. The clinical ladder program outlined in this article represents what is believed to be the first use of Carper's work as an organizing framework in program development and implementation. Carper's description of the dimensions of nursing knowledge was found to be consistent with the Board of Nursing description of professional nursing and provided one method to organize and conceptualize the clinical ladder program. Interest and participation in the program has exceeded the initial projections, with minor modifications to the program made based on qualitative feedback from participants. A formal evaluation of the program will be forthcoming to identify significant differences between participants and nonparticipants in the program, using specific measures of the overall goals and objectives of the program.