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I’m going to share a secret: it doesn’t.
Not really. Well, not necessarily.
While Magnet hospitals may have better outcomes, there are a number of factors at play: these hospitals are larger, better funded, and can do things to draw better staff. These hospitals have better outcomes partially because they have better equipment. These hospitals are regularly funded by either government grants or gracious generosity from the community; money isn’t everything, but it certainly helps.
In the meantime, CLPs emphasize employees doing more for the hospital in exchange for a bonus or a one-time percentage raise. From the Administrative side, this is wonderful! Nurses are often paid a pittance as their “raise” each year; I know my hospital (which is generous!) doesn’t even keep up with inflation. Nurses who start working with my level of experience regularly start at a rate higher than I enjoy; despite my decade of experience and loyalty to the same facility. Like many other jobs, the only way to get a raise, really, is to leave and come back later. But what if one doesn’t want to leave? What if one wants immediate recognition of clinical experience or education?
Herein lies the bribery of The Clinical Ladder.
The Magnet model (trademarked by ANCC), includes “empowerment” and “clinical practice”. Hospitals then use their CLP as an example of how nurses are able to have their own autonomy, empower themselves, continue education, expand professional development, participate in quality improvement, etc, etc. It’s a double whammy. While nurses spend countless hours preparing projects (quality improvement or otherwise; sometimes true research) and education programs for their peers in their non-clinical time, they have to continue doing these things every year. One must continually educate oneself, get new (expensive) certifications, become a relief charge nurse, do other projects, etc. in order to stay on the ladder. What exactly does that mean? In order to not have the raise taken back (at the current percentage, mind you), the Clinical ladder nurse must continue giving at the same rate. Every. Single. Year.
Oh. COVID-19, you say?
Ah! Does not matter. Did you do your charitable contributions? Did you make your poster? Did you recertify? Did you do a lengthy year-long project along with education? Did you document all of it? Did you update everyone monthly, quarterly, and yearly? Did you update the website? Did you fill out all the required forms? Did you take pictures?
Ah. Good. Well then, I guess you can stay.In the meantime, the hospital is receiving free advertisements (charity while wearing hospital shirts; not paid, but may still contribute toward the ladder) and free work. Educators are being assisted in education. People are spending money on their own supplies to make posters; the hospital isn’t paying for the labor or the supplies (although they would likely insist that they will; the process is a pain and not worth the complaints about overtime or documentation). It makes the hospital look good; these projects can have pictures taken and have the documentation sent to ANCC for Magnet Certification!
While life is falling apart (as an example: I lost two family members last year, one this year already, and developed various new and exciting health issues), one must maintain one’s previous level of involvement. This includes committees, of course! You have to demonstrate your devotion to the hospital and ongoing quality improvement, right? One must email summaries of these meetings to the entire unit, present at staff meetings, etc. If life is falling apart, so be it. Clinical ladder waits for no nurse. If it’s too much, maybe you shouldn’t be on the ladder (insert guilt here). You can reapply later, when you’re more capable of fulfilling your responsibilities.
But in the meantime, in the middle of hardship, the percentage is lost (because you’re not doing the extra work that is required for that one-time raise that you got).
I can see why hospitals like CLPs so much. There’s a lot of extra work that is basically free after the first year. It creates examples for Magnet. It helps to promote research and other quality improvement projects that would otherwise require hiring more people. It’s much cheaper just to bribe one’s own employees to do more with less and then do more after that. It makes the hospital look good. It promotes research that many nurses wouldn’t otherwise want to do. It promotes involvement in the hospital. It makes the hospital look like there is upward mobility and some standards for why some nurses make more than others, not just the usual garden variety favoritism. It makes the hospital look like there are scientific standards and that nursing isn’t just about doing the job, consistently, day to day. It is about science and standards. It is about innovation. Future. It is about revolutionizing healthcare! It makes every nurse feel more responsible and promotes buy-in.
There’s really almost no downside for the hospital, except for the money, of course. Even so, a one-time 5% raise? Cheaper to give 10 of those than to hire a full-time quality control nurse. Cheaper to give 10 of those, than to hire a full-time nurse researcher. Cheaper to give another 10 of those, than to pay according to experience, loyalty, and things that only accrue over time without providing extra benefit to the hospital. It’s so much more cost-effective; it’s attractive to newer nurses who could get a 10% raise, right off the bat by having their BSN and a certification (as well as a council and various extra works over the year). It looks great from the outside, it helps with certifications, it’s extra work for cheap… there’s just no real downside.
Except for the nurses.
While the hospitals give lip service to “work-life balance”, they also tell you to control your career and advance yourself. Ah, but without new degrees or different jobs, the only way is the ladder! Which mandates more work.
And takes one away from life.
But this is all okay as long as nurses continue to identify personally as nurses, rather than human beings and people; they will see themselves as a part of a greater calling. As long as nurses identify as nurses first, they will continue to give even to their own detriment. As their mental and physical health fails, their spouses age, and their children graduate from school, nurses will re-evaluate this stance. By then, it will be too late for them.
They will have given the best years of their life and the best of their lives to their hospitals. Their energy, their faith, their optimism, their health, their lives will have been spent in service to their patients, but even more, to their hospitals.
And in exchange, they’ll get a small percentage (once) and maybe a pin. Oooh. Maybe a hospital-branded mug or water bottle.
But damn, if it isn’t cost-effective!Published in