Publication Date

Spring 2026

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Alice Butzlaff

Keywords

Peer support, Clinical ladder program

Abstract

Continuous professional development among nurses is vital, yet not all nurses embark on this career journey. The Clinical Ladder Program (CLP) is a retention strategy among various health institutions to retain talent and improve nurses' satisfaction, but this plan is unappealing or indifferent to some nurses. While the CLP is a motivation tool for nurses to focus on clinical expertise in bedside care (Riley et al., 2009), and resources are available to increase a nurse's chances of successfully advancing the ladder, participation in and perspectives on the CLP remain unknown, especially among operating room nurses. This project is guided by Jean Watson's Caring Theory and Model for Improvement from the Institute for Healthcare Improvement (IHI) to improve familiarity and participation in the institution's clinical ladder program. An IRB-approved quality improvement project that used an online survey to assess operating room nurses' perceptions and barriers to participation in the clinical ladder program was conducted across all service lines. The survey findings were used to guide the peer support provided and the presentation of the nurse peer's personal experience in the CLP. Survey results showed the different strategies and types of support that can help increase motivation and participation in the program, and who can provide the most support as vital. In addition, it revealed several themes regarding the overall importance of support and the effect of the Assessment Clinical Expertise on participants. Incorporating the pre-survey findings into the peer support information session and activities helped increase the number of nurses participation and familiarity in the CLP and progress successfully in the process. Moreover, results of the survey helped guide the project’s deliverables which are used to guide and support in their clinical ladder journey.

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