Nurse Board Certification, Advanced Degrees, and SNIII Clinical Ladder Rates Continue to Rise

The acuity and intensity of patient care increase with each passing decade. Nurses must make complex decisions, adapt to ever-changing technology, understand health policy, and integrate seamlessly as a team.

Research has shown that hospitals and medical centers with higher percentages of nurses with Bachelor of Science (BSN) degrees and board-certified nurses have lower rates of patient morbidity and mortality.

In 2019, 22.1% of all eligible Salinas Valley Health Medical Center nurses held professional board certifications. The target for fiscal year 2023 was 34.9%. The organization continues to offer the support and incentives implemented by the Magnet® Steering Committee and The Professional Development Council in 2019. The strategies have been so successful that the Nursing Leadership Council has continued to set 1% annual improvement goals.

The successful increase in nursing board certifications to 35.51% in 2023 was due to a number of strategies: The organization continued to offer certification review courses presented by our own subject matter experts, new review courses were offered, and we continued to partner with outside experts to teach review classes to our nurses. Leader support for a total of six course offerings during fiscal year 2023 contributed to exceeding our goal of 34.9%.

Specialty-specific board certification information is regularly posted on the Professional Development Bulletin Board and on the units. On Certified Nurses Day, recognition activities and rewards are provided for all board-certified nurses. A poster listing all the names of board-certified nurses is on continuous display in the medical center lobby.

The percentage of nurses holding a BSN degree or higher continues to rise. In 2018, 50.3% of nurses had at least a BSN; by the end of fiscal year 2022, that number had jumped to 66.1%. For fiscal year 2023, nurses with a BSN or higher went up to 68.25%, exceeding the year’s goal of 67.1%. The growth rate for percentages of nurses holding a BSN or higher was 2.1%, 5.4%, 3.7%, 4.6%, and 2.15%, respectively, for the years the tuition incentive program has been offered.

Nursing Board Certification results each year have exceeded the target by 1.7%, 0.6%, 3.3%, 1.2%, and 0.61%, respectively.
Nursing Board Certification results each year have exceeded the target by 1.7%, 0.6%, 3.3%, 1.2%, and 0.61%, respectively.

Salinas Valley Health Medical Center has a clinical ladder program for nurse advancement. Nurses with less than 2,080 hours of experience will be placed in the Staff Nurse I level. When the nurse completes 2,080 hours, they are moved to the Staff Nurse II level. Currently, the highest level is Staff Nurse III (SNIII), and nurses have the ability to advance to this level through a formal application process. The SNIII program is a long-standing part of the clinical ladder program that was established to provide nurses the opportunity to advance professionally by demonstrating engagement and clinical expertise. The program has evolved since its inception, with regular revisions that are driven by feedback from stakeholders and evaluated by a task force of clinical nurses from the SNIII Review Board and the Professional Development Council.

The changes were meaningful for clinical nurses and increased their engagement and participation in the clinical ladder. Recent changes to the guidelines included aligning guidelines with the Magnet® Model components, formalizing a category for nurses to earn points as a Champion or Mentor and decreasing the wait time for nurses to present their portfolio after submitting their letter of intent. In October 2018, there were a total of 16 SNIIIs, and there has been a steady increase with higher numbers following a 2021 guideline revision.

Nursing Turnover Rates Improve

Nursing turnover has increasingly been a topic for discussion in the healthcare industry across the country. There are many implications for organizations when discussing nursing turnover, such as the cost to an organization when a nurse leaves and challenges finding nurses due to the market demand and shortage. Salinas Valley Health Medical Center has been tracking nursing turnover data for many years. As part of our continued growth as a Magnet® organization, the Professional Development Council was leveraged to monitor and improve turnover rates.

The Human Resources Department provides nursing turnover data on a quarterly basis, which is reviewed at Professional Development Council meetings. This team identifies areas of concern and discusses strategies for retention. The national average for nursing turnover is 22.5%, and Magnet-designated hospitals of our size (201 to 300 beds) average 12.16%. In July 2022, the Professional Development Council reviewed fiscal year 2022 data and established an organization goal to decrease nursing turnover, which was 12.85%, by 0.5% for fiscal year 2023. This council continued to monitor data for trends and opportunities, and nursing turnover decreased by 2.45% to 10.40% by the end of fiscal year 2023.

Infographics of Clinical Ladder RNIII Growth and nursing organizational turnover rates.
Infographics of Clinical Ladder RNIII Growth and nursing organizational turnover rates.

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