Evaluating the benefits of a clinical ladder for nursing staff: an international review.

This paper reviews the use of clinical ladders for nursing staff and examines the extent to which their claimed benefits have been realised, on the basis of available published research-based evaluation. A 'clinical ladder' is a grading structure which facilitates career progression and associated differentation of pay by defining different levels of clinical practice. The review examines publications from the United States, New Zealand, Australia and the United Kingdom. It notes that the vast majority of publications are descriptive 'this is how we did it' articles which do not provide any evaluation. The relatively few published evaluations are assessed, and it is concluded that the evidence base for supporting the claimed benefits of the use of clinical ladders is fragmented. Methods of evaluation have varied between studies, and in some cases fall short of that required for objective analysis.