Designing a Clinical Ladder for CRNAs in an Integrated Academic Healthcare System


The purpose of this DNP project was to design an evidence-based clinical ladder for the Certified Registered Nurse Anesthetists (CRNAs) in an academic integrated healthcare system in the southeastern United States. Clinical ladders are professional development and advancement programs to reward and recognize excellence in clinical practice. Clinical ladders can improve work engagement, job satisfaction, and retention. Currently, CRNAs in the local system are experiencing staffing shortages and exhaustion due to the COVID-19 pandemic. There is added strain on the CRNA leaders to recruit and retain valuable employees. The local system lacks a formal professional development program for CRNAs.


The design of the clinical ladder is based on current literature, a survey of CRNAs in the system to seek feedback on professional activities or components to be included in a CRNA clinical ladder, and a guideline from a CRNA clinical ladder at an enterprise partner organization. Common themes throughout the literature include the benefits of clinical ladders, the design of clinical ladders, and the importance of leadership support and mentorship in professional development programs. Evidence-based practice (EBP) is incorporated into the design of this clinical ladder. Healthcare quality and safety are improved by incorporating EBP into professional development programs. Organization and leadership support are vital to the success of a clinical ladder program. The project leader formally met with the Chief CRNAs to share key points about the benefits of clinical ladders, emphasizing employee engagement, job satisfaction, and a clinical ladder as an innovative strategy for retaining valuable employees.


An evidence-based clinical ladder for CRNAs in an academic integrated healthcare system was designed and is ready for implementation. The project leader recommends pre-implementation and annual assessments of employee engagement, job satisfaction, and retention. A detailed Guideline for the CRNA Clinical Ladder and an Application Packet for Advancement to CRNA II status were developed.


Clinical ladders have been studied widely in nursing, but there has been a gap in the literature concerning clinical ladder programs for CRNAs and other Advanced Practice Registered Nurses (APRNs). This project is a step forward in the exploration of clinical ladders and their benefits for CRNAs. CRNAs will be empowered in their own professional development and advancement while engaging in a clinical ladder. The CRNAs who participate in the clinical ladder will engage in departmental and organizational activities, leading to improved interprofessional collaboration and job satisfaction. The design of this CRNA Clinical Ladder can serve as a guideline for organizations seeking a CRNA professional development program. This clinical ladder design can be generalized to all APRNs and Advanced Practice Providers (APPs) with modifications to fit individual organizational systems and cultures.