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Promoting Professional Development:
Three Phases of Articulation in Nursing Education and Practice
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c This article presents the emergence and maturation of career ladders in nursing
education and practice over a period of forty years. It advocates for research to determine
the amount, type, and measurement of clinical experience that is essential for progression
along academic and clinical career ladders
Career ladders developed in the United States (US) as a seminal response to Dzthe
war on poverty,dz a social and political movement. The War on Poverty was launched in the
US by President Johnson in 1964 as a showcase program of the Great Society Era. It
expressed the cherished American dream, namely, that education could help people rise
from poverty. President Johnson spoke of the war on poverty as giving underprivileged
young Americans Dzthe opportunity to develop skills, continue education, and find useful
workdz (Halsall, 1998, p. 1). Reissman and Popper (1968), sociologists of this period,
described how ordinary people could combine education and job progression to achieve
their economic and professional aspirations. Because of the opportunities presented by
career ladders, there would be Dzno dead enddz careers, or as Ramphal (1968) expressed it,
no Dzstunted professional nursesdz. It was expected that these career ladders would offer, to
those nurses whose early educational choices made it difficult to use education as a mode
of career advancement, new opportunities to build on their past learning and experience.
This possibility re-awakened the Dzrags to richesdz myth and appealed to diverse publics:
politicians, industrial leaders, employers, and the general public. In career ladders were
envisioned as planned, coordinated, and well-articulated academic programs designed to
help people move up the academic hierarchy in a step-like manner. The metaphor of a
ladder emphasized that each step would provide new, not repetitive, knowledge and skills.
Although the career ladder concept could have been applied initially at any level of the
academic hierarchy, it found a first and welcoming home in community colleges.

 
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...the first phase of career ladders in nursing was spiral staircases. Nursing and allied health
programs became particularly popular academic offerings in community colleges. The
elaborate educational entry and exit path to professional nursing was recognized by early
leaders in the community college movement as a prototype of Riesmanǯs and Popperǯs
(1968) career ladder. Community college administrators found nursingǯs multi-level
educational approach to professional practice to be a career ladder designed in heaven.
Students could become licensed practical nurses, work while they completed associate
degree programs, and achieve eligibility to write the National Council Licensure
Examination for Registered Nurses (NCLEX-RN). As registered nurses (RNs), associate
degree nurses (ADNs) were eligible for good jobs in the nationǯs healthcare industry.
Because few hospitals differentiated among the educational preparation of nurses, ADNs
successfully competed for the same positions and salaries as baccalaureate and diploma
graduates.
In the 1960s, registered nurses who sought Bachelor of Science in Nursing (BSN)
degrees embarked on a program involving an additional two to three years of study in a
baccalaureate program. It was easier for ADNs than for hospital school graduates to
articulate career ladders because ADNs had earned lower division college credit in their
community college programs. With advance placement examinations and liberal policies
for transfer of credit, it was possible for some ADN graduates to enter four year nursing
schools as full-time, junior-year students and graduate with their class. However there
were no assurances that the curriculum in community colleges resembled programs of
study in four-year colleges and university schools. Diploma graduates learned that while
their hospital-based programs emphasized clinical competence, their transcripts did not
show academically recognized courses in basic and social sciences and the liberal arts. RNs
who moved frequently or changed schools also faced special challenges on first-generation
career ladders. Many of these nurses learned that some of their credits were not
transferable. It was not uncommon for some registered nurses to literally start over again
because it was so difficult to articulate their programs of study with the nursing
curriculums in four-year colleges and universities. In addition to the complexity of
articulating nursing curriculums across schools, there were policy disagreements among
nursing leaders, including different interpretations of policy documents; ambiguity about
the nature of career ladders and modes of entry and exit; and disagreements about
whether there should be separate programs for diploma/ADN (RN) and generic students or
a unified curriculum for all undergraduate nursing students

 
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Social forces encouraged the development of achievable academic career ladders.
These forces included the 1965 American Nurses Associationǯs (ANA's) first position
statement on the education of nurses; work place policies requiring BSN degrees for
advancement; early support from nursing associations, notably the National League for
Nursing (NLN) and the National Student Nurses Association; growth in associate degree
programs; closure of many diploma schools; and enhanced financial aid for all levels of
nursing education. Later, the success of the nurse practitioner movement, acceptance of
certification for advanced practice nurses, and improved employee benefits which
provided tuition assistance and a growing professionalization in the nursing community
encouraged more nurses to return to school. These more mature career ladder programs
focused attention away from particular courses and progression policies toward the end
point, the achievement of the desired terminal degree as quickly as possible. The second
phase in nursingǯs career ladder trajectory expanded and extended academic articulation
beyond entry-level programs, blurring the boundaries which separated the levels in
nursingǯs academic hierarchy. Once nursing overcame hurdles to success on career ladder
programs by developing accessible, feasible, academic-articulation patterns, it spawned an
amazing number of curricular ladders and lattices. These included: BSN programs for
college graduates (accelerated programs); first professional degree programs at the
masterǯs level; nurse doctorate programs (ND); ADN to Masterǯs of Science in Nursing
(MSN) programs; BSN to clinical nurse leader (CNL) programs; BSN to MSN and BSN to PhD
programs; BSN to the Doctor of Nursing Practice (DNP); MSN to PhD; and MSN to DNP
programs. These more mature career ladder programs focused attention away from
particular courses and progression policies toward the end point, the achievement of the
desired terminal degree as quickly as possible.

 
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The third phase of the career ladder continuum links academic progression to the
development and demonstration of clinical and professional competence and to
advancement in the workplace. Hospital clinical ladders, which proliferated in the eighties,
were oriented to assuring clinical competence, recognizing performance rather than
longevity, addressing recruitment and retention, and encouraging and rewarding bedside
nurses who elected to stay at the bedside rather than pursue administrative careers. This
third phase of the career ladder continuum is characterized by variety and diversity in the
number and type of clinical and educational advancement pathways. Diversity is reflected
in established clinical pathways in both acute and long-term healthcare environments.
Recently, attention has been given to clinical/academic career pathways for clinicians, as
more clinicians are engaged by schools of nursing to teach clinical courses.
Academic accreditors and evaluators examined structures and processes, such as
faculty preparation; the curriculum; academic governance, transfer and progression
policies, and student preparation and success within the program. They also examined
admission and progression policies, processes related to academic planning and
scheduling, grading structures, student and faculty selection policies, and graduation
requirements. Health system accreditors also looked at clinical structures and processes,
measuring progress in these indicators and basing accreditation decisions more on
structures and processes than outcomes. The assumption that there is one way or one
Dzbestdz way to get from here to there has guided academic and clinical thinking for many
years. In contrast, the current emphasis on outcomes envisions the desired Dzproduct,dz for
example the competency and readiness for practice; capacity in the use of evidence and
findings from research; or the ability of health systems to consistently achieve their goals of
health improvement and safe, quality care. Curriculum or system planners, reflecting on
the desired end states, can now move beyond a lock-step approach to nursing education
and create multiple pathways to achieve the desired goals. While it is still possible to mock
nursingǯs complex entry- and exit-articulated curriculum models, contemporary students
can achieve their academic and professional goals more efficiently today than they could in
the past, without the challenges of built-in redundancy and delay.
Although hundreds of articles have been written over the past forty years about
nursingǯs career ladders, issues which transcend academic/professional borders remain.
One issue is the value which nursing bestows on the achievement of clinical experience in
educational programs. Nursing leaders have failed to reach agreement or consensus about
the amount, type, and measurement of the clinical experience necessary for academic or
clinical advancement. Additionally, divergent opinions exist among nursingǯs leaders,
faculty, and nurses at the point-of-service regarding the clinical experience needed before
seeking additional academic preparation. There are also differences of opinion about the
amount, type, and measurement of clinical experience necessary to meet licensing,
accreditation, and certification standardsc
c

cc
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In this article the authors present the evolution of career ladders in nursing
education and practice and discuss their development, maturation, and institutionalization
in three phases over a span of forty years. In phase one, academic career ladders were
spiral staircases, complex, confusing, and poorly articulated entry and exit pathways. Phase
two saw the maturation of career ladders across all levels of nursing education and
practice. In phase three, academic and clinical career ladders, built upon theoretical
perspectives, have enriched academic programs and clinical practice and increasingly are
being integrated into the curriculum, clinical advancement programs, and the magnet
hospital movement. The authors conclude by discussing continuing questions, such as the
amount of clinical experience needed in an educational program and the amount of clinical
practice needed before seeking an advanced degree.
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