Clinical ladder development: implementing contract learning.

Expanding the clinical ladder concept in nursing at the Presbyterian Hospital in New York prompted the Department of Education, Research, and Development to further implement contract learning as an innovative adult education technique. The process was applied in orienting new Clinical Nurse IIs (experienced nurse preceptors) and Clinical Nurse IIIs (assistants to the Nursing Care Clinicians) to their advanced clinical roles. The process of implementation, the development of learning contracts, and the week-long workshop designed for each of the new clinical leaders is discussed.