Clinical Advancement Programs (CAP): Taking the Lid Off Your Potential

Clinical advancement programs (CAP) have proven to be an integral part of professional development for nursing at many healthcare facilities for years.¹ The Journal of Nursing Administration reports that in order to achieve Magnet recognition by the American Nurses Credentialing Center, hospitals must demonstrate a clinical environment that supports and encourages professional development by utilizing tools such as clinical advancement programs.² Tower Health’s Reading Hospital, a designated Magnet hospital, currently provides a nursing career advancement program and recently has begun to adopt this best practice for its allied health professionals. The respiratory therapists, surgical technologists, and patient care assistant groups have all successfully developed and launched similar programs. In the fall of 2017, a team of allied health professionals of the Cardiovascular and Interventional Radiology Services (CVIR) developed an advancement program for technologists in their division. It was implemented in the spring of 2018.

The division, excluding leadership, is comprised of 87 non-ancillary staff members, with 57% being allied health professionals (Figure 1). The development team included technologists from interventional radiology, cath lab, echo, vascular, nuclear medicine, cardiac rehabilitation, the divisions’ clinical nurse specialist, a nursing clinical advancement program representative, and a nurse manager. The primary challenge was to develop a system that was applicable to the multiple disciplines of practice found within the division. What was attainable for a cardiovascular technologist needed to be attainable for an echocardiography technologist.   

The team began by asking each discipline which tasks they perform that they felt were “above and beyond” their expected job descriptions. For example, precepting, research, tenure, education, and community service. These contributions were then divided into 5 attributes: Clinical Practice/Process Improvement, Professional Practice/Leadership, Community, Education, and Experience. Points were assigned to each task and level. As one grows in their profession, more points and attributes are required to progress to a higher level of the matrix.  In alignment with Patricia Benner’s model for nursing, it encourages a well-rounded approach to professional development and rewards for broad growth versus just skill set advancement.³

The team presented the completed matrix to the divisions’ leadership team, the organization’s Professional Practice Council, and human resources. The program was given full approval and launched in July 2018.

The Clinical Tech Career Advancement Program is governed by a board of peers consisting of level II and level III technologists, a nursing clinical advancement program representative, a clinical nurse specialist, and members of leadership. The team collaboratively approves all challenges and maintains the integrity of the program.

To date, 24 out of 51 CVIR techs have challenged to a level II or higher. Engagement of allied health professionals in shared governance, community service, and peer education has increased, and open collaboration among all disciplines is apparent throughout the division. Recent staff survey results show the implementation of this program has once again proven that such tools are successful at increasing employee engagement, elevating job satisfaction, staff retention, and encouraging professional development (Figure 5).

Following is an explanation of the matrix for the Clinical Tech Career Advancement Program:

• Level I is entry level, with minimal requirements. This technologist receives base pay and, once orientation is complete, must fulfill one professional contribution of their choice annually. Participation in level I is required; however, challenging to a higher level is optional (Figure 2).
• Level II requires a technologist to be in the field a minimum of a year and have the preparedness to broaden their contribution. A level II technologist is required to choose 4 out of the 5 listed attributes and must collect 4 points from each chosen category for a minimum total of 16 points. Points are accrued annually, and additional income is added to base pay (Figure 3).
• Level III is the highest level. This technologist must collect 5 points from all 5 attributes for a minimum total of 25 points. Points are accrued annually and additional income is added to base pay (Figure 4).

If level requirements are not maintained annually, the achieved level is removed, as well as the additional income. 

*Jessica Fackler, CVT-RCIS, has since left her position with Tower Health. Diane Luchetta, MSN, RN, RCIS Nurse Manager, can be contacted at diane.luchetta@towerhealth.org.

1. Watts MD. Certification and clinical ladder as the impetus for professional development. Crit Care Nurs Q. 2010 Jan-Mar; 33(1): 52-59. doi: 10.1097/CNQ.0b013e3181c8e333.
2. Allen SR, Fiorini P, Dickey M. A streamlined clinical advancement program improves RN participation and retention. J Nurs Adm. 2010 Jul-Aug; 40(7-8): 316-322. doi: 10.1097/NNA.0b013e3181e93978.
3. Benner P. From novice to expert, excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley Publishing Company; 1984: 1-307.