Since the early 1970s, clinical ladder programs have been a method of defining, recognizing, and rewarding nursing practice. As clinical practice in an institution grows and evolves, so must the program that supports the development of the practitioner. An in-depth evaluation of one clinical ladder program was conducted to determine if it was reflective of current practice. The authors discuss the method of evaluation, findings, and the revised program.

Communication plays a vital role in an increasingly complex healthcare environment. Quality patient outcomes and successful collaboration depend upon the healthcare provider's ability to communicate needs. A self-directed work team at a large southeastern hospital used a quality improvement process to design a new series of workshops to enhance staff communication skills. The redesigned programming reduced duplication of education content and built upon a conceptual foundation that cultivates professional development. The workshops feature content such as self-awareness, personal effectiveness, and leadership of others.

The Professional Transitions Workshop is a new program that integrates the Professional Advancement Program (clinical ladder) and the Professional Model of Practice (primary nursing). Together, these two programs provide the philosophical and structural foundations of professional practice and empower nurses to articulate the defining features of their clinical experiences. Educating staff members about these programs emphasizes critical thinking and storytelling as important skills for the professional nurse. The authors describe the advantages, processes, and outcomes of this change.