title: A clinical advancement program: evaluating 10 years of progressive change.
abstract: OBJECTIVE
  To report the evolution of a clinical advancement program, UEXCEL, at a western teaching hospital and the outcomes associated with evaluation over time.
  
  
  BACKGROUND
  The clinical ladder program was initiated in 1989 to provide a professional framework for developing, evaluating, and promoting registered nurses. The program is derived from Benner's Novice to Expert model. Over a 10-year period, the program has undergone three significant revisions. Program evaluation data have been used to guide institutional change.
  
  
  METHODS
  Structure and progression of program development and change are outlined. Evaluation data were collected using a 23-item clinical ladder satisfaction scale developed by Strzelecki. Data were collected in 1993, 1994, 1996, and 1998 using standard survey methods after institutional review board approval. Subjects were registered nurses holding clinical positions at the University of Colorado Hospital. Data were trended across units and time periods and were compared with other institutional evaluation data sets.
  
  
  RESULTS
  Improvement in nurse satisfaction with the UEXCEL program has been steady and incremental, after low baseline measurement. Satisfaction has improved after each program revision. A significant demographic variable over time is the correlation between higher registered nurse education and program satisfaction. Human resources issues are reported with data results.
  
  
  CONCLUSIONS
  Sustaining a clinical advancement program represents a challenge in the current health-care environment. Institutional commitment, staff involvement in revisions, and activities to improve professional nurse development are critical strategies so progress can be achieved.
authors.affiliation: Department of Patient Services, University of Colorado Hospital, Denver, USA. Mary.Krugman@UH-Colorado.edu
authors.forename: M
authors.initials: M
authors.lastname: Krugman
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.forename: C J
authors.initials: CJ
authors.lastname: Goode
mesh_terms: D002322:Career Mobility; D003120:Colorado; D003406:Credentialing; D006801:Humans; D007588:Job Satisfaction; D017146:Models, Organizational; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010559:Personnel Management / Q000191:economics; D015397:Program Evaluation