Clinical Ladder

The Duke Clinical Ladder program exists to recognize the expertise of nurses who make a difference at the bedside, and provide clinical leadership in their department and institution, as well as on regional and/or national levels.

The Clinical Ladder program at Duke has three distinct tracks: Education, Practice and Management.

The Clinical Ladder program is completely self-selected (except level II All nurses are required to advance from a CN I to a CN II within 18 months). Participation in level III and IV is not mandatory, nor is there a limit on the number of nurses who can participate in the program.

Eligibility requirements and rewards for nurses at various levels are as follows:

Clinical Nurse I (CNI)

• Nurses with less than 12 months experience are hired as a CN I
• Compensation changes annually

Clinical Nurse II (CNII)

• Nurses with greater than 12 months experience hired as a CN II
• Internal nurses must be promoted to a CN II within 18 months
• There is not an application process
• Internal candidates receive a lump payment when promoted to a CN II

Clinical Nurse III (CNIII)

• Nurses with 3+ years of experience are eligible
• Completed application required for program participation
• Compensation = 5% increase
• Administrative time = 52 hours

Clinical Nurse IV (CNIV)

• Nurses with 5+ years of experience are eligible
• Completed application required for program participation
• Compensation = 6% increase
• Administrative time = 104 hours

A variety of accomplishments and activities, from patient education and participation in community health programs, to presentations at professional conferences, are factored into considering those recognized under this program.