Reach for Excellence--a clinical ladder promotion system

The clinical ladder at Lutheran Hospital-La Crosse, La Crosse, Wisconsin, exemplifies the decentralized management of the department. The four-tiered promotion system rewards the nurse who uses clinical expertise to promote high quality nursing practice by functioning as role model, resource, teacher for colleagues, and change agent. Specific criteria comprise the Performance Description/Appraisal and build through each level of the ladder. Applicants submit a portfolio to peer review committees. Salary increases accompany promotion.