Clinical career ladders: the Washington Hospital Center.

The clinical career ladder program developed for pharmacists at The Washington Hospital Center, an 852-bed not-for-profit teaching institution, is described. Many new pharmacists hired during a period of rapid departmental expansion from 1979 to 1984 lacked the knowledge and skills needed to practice effectively in an increasingly complex clinical environment. The existence of a single class of staff pharmacists led to inequities in salaries. A continuing-education program was instituted, but some mechanism of motivating the pharmacists and correcting problems in recruitment, retention, and productivity was needed. In 1984 the department implemented a clinical career ladder with four levels: staff pharmacist, clinical pharmacist, senior clinical pharmacist, and clinical services manager. Duties and responsibilities range from drug distribution, technical supervision, and provision of basic drug information at the staff pharmacist level to supervision of pharmacy services in specified patient-care areas, administrative supervision, and program planning and development at the clinical services manager level. Equity adjustments were made when the program was implemented. Employees who meet the minimum requirements and have received above-standard performance evaluations are considered for promotion. To be promoted to clinical services manager, an employee must apply formally. The program has reduced turnover, particularly among the most highly skilled and productive employees, and has attracted new employees. A career ladder eased problems in employee retention and recruitment, eliminated wage inequities, and became an important motivational force for the professional staff.