Publication Date

Spring 2026

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Lisa Walker Vischer

Keywords

Clinical ladder program, professional development, nurse managers, educational framework, Caring Science, professional development

Abstract

Background: Clinical Ladder Programs (CLPs) offer a structured pathway for nursing professional growth, fostering clinical excellence while improving nurse satisfaction and longterm retention. Although nurse managers play a pivotal role in facilitating the CLP, there is currently no comprehensive educational framework to enhance their knowledge and confidence in supporting clinical ladder advancement. Purpose: The aim of this DNP project is to develop implement, and evaluate an educational framework grounded in Benner’s Novice-to-Expert framework and Watson Caring Science® to enhance nurse managers' knowledge and confidence in leading nurses towards clinical ladder success. Methods: In a quasi-experimental study using a single-group, pre-post paired t-test design, nurse managers participated in interactive learning modules that offered continuing education credit. Knowledge of Benner’s domains, CLP requirements, and self‑reported confidence across four areas aligned with the Kirkpatrick model were assessed using three evidence‑based tools. Results: Matched participants (N = 34) demonstrated significant gains in Knowledge Test scores (pre-M = 50.59; post-M = 87.35; Δ = 36.76; p < .001) and across all Confidence Domains (p < .001). Reliability improved from α = .70 to α = .84; nonparametric sensitivity analyses confirmed robustness. Conclusions: Higher levels of knowledge were associated with significant increases in confidence, demonstrating that a comprehensive, theory-informed educational framework can lead to substantial, statistically significant improvements in nurse managers' knowledge and confidence in developing and maintaining clinical expertise and in influencing clinical ladder success.

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