A clinical ladder for the community health-care setting

A clinical ladder for occupational health nurses

Occupational health nurses must have a growing, expanding knowledge base to remain current in practice. The American Board for Occupational Health Nurses, Inc. encourages advancement with the availability of certification examinations. Health care centers support clinical advancement programs for bedside nurses. Nurses who continue their education either through a degree program or via continuing education or certification advance up the clinical ladder, receiving a higher salary, recognition from their peers, and perhaps even financial assistance to continue climbing, yet occupational health nurses do not have their own clinical advancement ladder. This article examines the steps necessary to develop a clinical ladder and presents a clinical ladder specific to occupational health nursing developed by the author.

A Clinical Advancement Program for Registered Nurses With an Outpatient Focus

Clinical advancement programs have been in use for almost 30 years. Although clinical advancement programs have been designed for many areas, it appears that one has never been developed specific to the outpatient-focused registered nurse. This article describes the development of a clinical advancement program for non-hospital-based registered nurses employed at the Guthrie Clinic in Sayre, Pennsylvania and highlights recommendations for instituting this program in any outpatient setting.

Models of differentiated practice and specialization in community nursing: a review of the literature

In most agencies for community nursing at least two types of nurse are employed. To ensure efficient use of personnel and high quality of nursing care, the principles of differentiated practice and specialization are used. It is suggested that these types of work redesign will have consequences for nurses and their work. We made a review of the literature to see how these principles are used and their effects on job satisfaction, burnout and quality of care. This review provides several views and descriptions of nursing activities, but it also shows that there is a paucity of quantitative data about the effects of differentiated practice and specialization in community nursing. To study these effects more systematically, a research model is presented. This model makes it possible to describe the changes in job characteristics caused by differentiated practice and specialization. Secondly, it allows the effects on job satisfaction, burnout and quality of care to be studied.

The effects of job characteristics and individual characteristics on job satisfaction and burnout in community nursing

The aim of this article is to describe job satisfaction and burnout among two categories of community-based nurses (N = 402) in the Netherlands taking account of job and individual characteristics. Results show that these nurses are moderately satisfied with their jobs and the effects of burnout are average. Further, community nurses are less satisfied and have experienced burnout to a greater extent than community nurse auxiliaries. Both job characteristics and individual characteristics are related to job satisfaction and burnout. However, job satisfaction is affected to a greater extent by job characteristics whereas burnout is more often a result of individual characteristics. As research in this area is scarce and home care is changing radically, these results may be valuable in coping with change without losing sight of nursing's professional values.