Transforming a Nurse Practice Advancement Program for the New Millennium

Clinical ladder programs originated in the 1970s as a method to promote professional growth and as a means to reward and retain experienced clinical nurses at the bedside. A Clinical Ladder and Nurse Residency program has been in place at NYU Langone Hospital Center since the early 1970s with periodic revisions through 2014. This article will outline the methodology of restructuring and modernizing a static model, from a manager-led model to a peer-led process, to align with the organization's growth and evolving clinical practice utilizing the Lean model. This process is the first of several phases in a 3-year development plan. Outcome metrics will include increased retention and promotion rates.