EVALUATION OF A NURSING CLINICAL ADVANCEMENT SYSTEM (PROMOTION).
Contributors: University of Rochester.
Published: 1991
Number of pages: 203
Subjects: Health Sciences, Nursing.; Sociology, Industrial and Labor Relations.
Description: A medical center nursing clinical advancement system (MC CAS) was evaluated using the CIPP model (Stufflebeam, 1983) which addresses context, inputs, process and products of a program. Implemented in 1981, the MC CAS created promotional opportunities for nurses preferring to remain involved in direct nursing care.

Qualitative and cost data were collected from medical center files and through 31 loosely structured interviews of key administrators and staff. Quantitative data reflecting attitudes about job satisfaction, promotional opportunities, work rewards and intent to leave were gathered using the Index of Work Satisfaction (Stamps & Piedmonte, 1986) and several small scales used by Curry, Wakefield, Price, Mueller, and McCloskey (1985). Staff nurse retention data were collected from personnel files.

Six hundred eleven registered nurses received the attitude survey. Three hundred sixty-two (54%) returned useable questionnaires, 152 (42%) from clinically advanced staff, 203 (56.1%) from non-promoted staff and seven (1.9%) with CAS level missing.

Positive findings included strong administrative and staff interest in building an advanced professional nursing model. All interviewees' perceptions of prevailing needs were similar and closely matched the objectives developed for the MC CAS. The participative management approach to planning the system was helpful. An accepted theory base for creating valid levels of nurses' clinical competency was lacking, however.

Negative findings included inadequate preparation of unit based nurse managers, resulting in role confusion among themselves and their clinically advanced staff. Despite clarification, this confusion prevailed, increasing when staffing shortages became severe. Other negative themes revolved around the application and promotion review processes, the heavy reliance on documentation as evidence of advanced clinical competency, and small monetary rewards for advancement.

With the exception of pay, organizational requirements and task requirement components, all subjects' aggregate scores on the attitude surveys were positive. Comparison of group scores revealed that clinically advanced subjects had slightly more positive opinions and fewer intended to leave.

Personnel files demonstrated lower turnover among clinically advanced staff. The imputed savings on turnover, however, were less than the costs of operating the system. The MC CAS, therefore, could not be justified solely on the basis of cost benefit analysis.
Notes: Source: Dissertation Abstracts International, Volume: 52-07, Section: B, page: 3533.

Thesis (ED.D.)--THE UNIVERSITY OF ROCHESTER, 1991.

School code: 0188.