Open Forum

Good evening!

We are currently reviewing and modernizing our RN Clinical Ladder program, and we are seeking to benchmark best practices from other organizations. I would appreciate connecting with anyone who has an established ambulatory nursing clinical ladder and is willing to share information about its structure, advancement criteria, incentives, outcomes, or lessons learned.

We are particularly interested in how organizations recognize and advance ambulatory nurses while aligning with broader system-wide professional advancement frameworks.

If you have resources, examples, or are open to a brief conversation, I would be grateful for your insights.

Thank you in advance!

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Giovanna A. Zito MSN, RN, CMSRN, AMB-BC, LSSGB
Nursing Professional Development Specialist
(E) –Giovanna_A_Zito@Rush.edu
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Here is what we have established in our organization.

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Terri Shaver BSN, RN
Director of Clinical Operations
Trinity Health IHA Medical Group
Ann Arbor, Michigan
734-747-6766
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Thank you, Terri! Does your org utilize any form of point-based system or certain # of examples needed from each area to advance?

Original Message:
Sent: 06-10-2026 08:01
From: Theresa Shaver
Subject: Ambulatory Clinical Ladder Examples

Here is what we have established in our organization.

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Terri Shaver BSN, RN
Director of Clinical Operations
Trinity Health IHA Medical Group
Ann Arbor, Michigan
734-747-6766
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When someone is advanced it is a promotional opportunity so their leadership will requested that they are moved up the ladder for either agreeing too, or they have already assumed that added responsibility.

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Terri Shaver BSN, RN
Director of Clinical Operations
Trinity Health IHA Medical Group
Ann Arbor, Michigan
734-747-6766
theresa_shaver@ihacares.com
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Original Message:
Sent: 06-10-2026 09:34
From: Giovanna Zito
Subject: Ambulatory Clinical Ladder Examples

Thank you, Terri! Does your org utilize any form of point-based system or certain # of examples needed from each area to advance?

Original Message:
Sent: 06-10-2026 08:01
From: Theresa Shaver
Subject: Ambulatory Clinical Ladder Examples

Here is what we have established in our organization.

------------------------------
Terri Shaver BSN, RN
Director of Clinical Operations
Trinity Health IHA Medical Group
Ann Arbor, Michigan
734-747-6766
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Hi Giovanna, I met you at the AONL NPG Conference in 2024! For our clinical ladder program, it is the same for inpatient and ambulatory nurses. When in orientation, you are a RN I. Then off orientation RN II. Then you apply for RN III and RN IV. See attached for the requirements to apply. You have to be certified to become RN III. Incentives: pay increase, RN IV gets 8 hours a week of time to do RN IV work. Most recently added the requirement of a resume to the application. 

One personal opinion, is I wish the RNIV's had to present their work, and/or have a portfolio. There is no yearly check to make sure people are doing the work to maintain their RNIV. And it is a big commitment for the hospital to give 8 hours a week for RN IV time, and coverage has to be found for that day. 

Happy to talk further! Kelsey