Clinical Practice Ladder Program Details

Download the application packet (ZIP of Word docs)

Review Process

  • The portfolio is submitted to the chief nursing executive administrative assistant.
  • Portfolio review and recommendations typically are completed within six weeks of submission.
  • Professional Development Committee (PDC) members will review the portfolio and make recommendations.
  • If revisions are needed, the portfolio is re-submitted within eight weeks. If the application is not re-submitted within this timeframe, the applicant must begin the process again.
  • The applicant will be contacted with a scheduled time to meet with the PDC.
  • The applicant’s nursing manager/director (or designee) will be invited to attend this meeting.
  • The applicant will present a summary of the portfolio and make remarks.
  • The applicant will be recognized with the designation on the Professional Practice Ladder at this meeting.
  • When the PDC recommends the applicant to Professional Practice Ladder status, a salary adjustment will be implemented the first pay period after approval.


  • Obtain application packet and review.
  • Make an appointment to discuss the process with the Clinical Nursing Education Department, if desired.
  • Develop portfolio contents.
  • Submit portfolio to the chief nursing executive’s administrative assistant.
  • PDC reviews portfolio and makes recommendations (within six weeks of submission).
  • Candidate meets with PDC to present portfolio.
  • Interview, presentation of portfolio and celebration!

Renewal of Professional Practice Ladder Status

  • Renewal of Professional Practice Ladder status is completed annually on the anniversary of the clinical nurse’s initial approval.
  • An abbreviated portfolio is submitted to the PDC. Contents of this portfolio include:
  1. A copy of the most current staff performance review summary form with rating of “3” (numerical based or higher signed by the nursing director).
  2. Documentation of a minimum of eighteen continuing education units completed by attending classes or programs coordinated by the medical center using a nationally-recognized organization or programs presented by providers other than those offered through the medical center (e.g. attendance at national meeting for specialty area, a webinar or college program to achieve a nursing degree – BSN, MSN ,or doctorate).
  3. Professional activities summary, including evidence to support performance category elements for six elements.
  4. One peer review
  5. Three measurable, objective professional goals for the upcoming year.
  6. A scoring form.
  • The renewal portfolio is submitted to the PDC for review annually, no later than six weeks prior to the anniversary date of the Professional Practice designation.
  • If the clinical nurse is on a leave of absence during the renewal period, the abbreviated portfolio is submitted within sixty days of return to work.


A Professional Practice Ladder nurse who transfers to another unit or department that is not a similar area of expertise, such as transfers from the intensive care unit to the emergency department or from a surgical unit to the maternity unit, may reapply for Professional Practice Ladder designation if they meet the performance criteria elements and submit a complete portfolio as described in the Maintenance of Professional Practice Ladder Nurse Status section. This process can be waived using the clinical areas defined in the Memorandum of Understanding (MOU, Side Letter Number 3) at the discretion of the PDC.

Appeal Process

Any applicant that is denied Professional Practice Ladder designation may appeal the decision of the PDC subcommittee as follows:

  • A written appeal stating the basis for the appeal must be submitted to PDC no later than thirty days after written notification of denial. The appeal should reference or contain only information submitted with the original application as justification of the appeal.
  • The PDC will review the appeal and accept the application or deny the appeal, providing a written explanation of the reasons for the written denial.
  • If the appeal is denied, the applicant may appeal the decision to the chief nursing executive (CNE) no later than thirty days after denial by the PDC. The original portfolio must be submitted to this nurse.
  • The CNE will render a decision within thirty days. The decision of the chief nursing executive is final.
  • Denial of an appeal does not preclude future application to the Professional Practice Ladder program.

The candidate must meet all of the following criteria to be eligible to participate in the Professional Performance Ladder:

  1. Current registered nurse employee working in a full-time or part-time (0.6 FTE or higher) position, a minimum of 1750 hours, hours actually worked, not paid for, during the 12 months previous to the date of application. The hour threshold in this paragraph is pro-rated for part-time employees based on actual hours worked, not on base FTE.
  2. Performance rating of 3.0 or higher in all categories of the candidate’s most recent annual staff performance review form.
  3. Have achieved and maintained national certification related to area of clinical practice.
  4. Has maintained a positive work record including no suspensions for the three years prior to application. Note: An employee can be deemed ineligible for consideration if they have received a verbal counseling in the three years prior to application. Eligibility will be at the discretion of the Chief Nursing Executive (CNE) based on individual case-by-case review. Each of these cases will be discussed with SEIU. The final determination of eligibility will be influenced by:
    1. How old the discipline is,
    2. The number of disciplines,
    3. The severity of the offense, and
    4. The relevance of the discipline to competent and safe clinical practice.
  5. Working at Alameda Health System for a minimum of 2 years as a registered nurse.

Note: The employee must maintain these requirements after the application/portfolio is submitted to remain eligible for consideration and compensation.

Guidelines for Application

  • The RN candidate should first complete the application form during the defined two-month application period and submit it to the Professional Development Council (PDC). The candidate’s portfolio must be submitted to the PDC within twelve months of submitting the application.
  • Within two months of submitting the application form (including approval by the nurse manager/director for any projects), the candidate is strongly encouraged to meet with the clinical education department staff to:
    • Discuss the application process.
    • Have questions answered.
    • Receive guidance/support in determining exemplar topics.
    • Review progress of the portfolio prior to submission to suggest enhancements
    • Discuss nurse manager/director approved projects.
    • Applications are available on the Alameda Health System intranet or from the Clinical Education Department.
    • The application/portfolio must be typed. Electronic submission of the completed application is encouraged and is submitted to the chief nursing executive administrative assistant.
    • Candidates are responsible for ensuring that the submitted application/portfolio is complete and accurate.
    • Candidates should retain a copy of the portfolio for their records prior to submission.


To recognize nurses as highly skilled and compassionate healthcare professionals who positively transform the experience of care within diverse populations.


The Alameda Health System Professional Practice Ladder is designed to promote professional enrichment and growth of our nurses.

Nursing excellence is a top priority in meeting AHS’s mission for outstanding patient care, education, research, and leadership. AHS supports personal responsibility, respect for self and others, innovation through teamwork, dedication to caring, and excellence in customer service. The program encourages nurses to take the initiative for professional growth and development in their clinical field, thereby enhancing quality of care, improving patient outcomes, and promoting nursing satisfaction.

The program is built upon AHS’s philosophy of nursing:

  • To provide a combination of professional and caring practices through:
    • clinical inquiry, research, and ongoing learning,
    • clinical judgment based on practice standards and nursing process,
    • advocacy, and
    • ethical application of practice standards.
  • To contribute to positive patient outcomes through planned collaborative care by professional nurses.

This program is based on a philosophy that recognizes the obligation of professional nursing to provide quality care for patients, their families, and the community.

The Professional Practice Ladder was designed by nurse clinicians, charge nurses, educators, and advanced practice nurses as members of the Professional Development Council with review, revision, and approval of the nursing leadership.


  • Support and promote the mission, vision, and values of Alameda Health System.
  • Create an environment that promotes high quality patient care.
  • Provide recognition and reward associated with the individual registered nurse’s level of professional practice and clinical expertise.
  • Provide a network of resources for clinical expertise, collaboration, research/evidence-based practice, peer review, and consultation for members of the healthcare team.
  • Promote clinical excellence in patient care and professional nursing practice through the encouragement, promotion, and support of professional development and engagement.

Our Vision:

Highest quality services for every person, every day, in every encounter.

Our Goal:

The nursing division seeks to support the mission and vision of Alameda Health System and build excellence in service through development and implementation of strategies that will “relieve anxiety during the healing process” for every person involved.

Strategic Direction:

Patient Focused Care

  • Recognize the patient or designee as the source of control and a full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
    • Enhanced collaboration and interdisciplinary teamwork.
  • Create an environment that allows the collective knowledge, resources, and skills of each team member to flourish.
    • Clinical scholarship and professional development.
  • Promote evidenced-based practice in the clinical setting.
    • Create an environment for advanced education and enhanced clinical expertise
  • Innovation and a culture of discovery.
    • Design and implement new and innovative processes that drive continuous performance improvement.
  • Shared governance and professional accountability.
    • Promote an environment in which clinical nurses have a voice in determining nursing practice, standards, and quality of care and are willing to take complete responsibility for nursing practice, patient care quality, and outcomes.

Shared Governance and Professional Accountability

We recognize that the nursing profession is vital to the success of any health care organization. As such, we commit to be self governing, ensuring that we are personally accountable to represent ourselves, the profession, and the medical center in the most positive light.  We also respect the magnitude of our responsibilities with respect to evidence-based practice, education and research, professional development, peer review, quality and safety, finance, and policy and practice.

Note: The Nursing Advisory Council structure will be consistent. Location-based advisory councils at John George and Fairmont and for Ambulatory Services will report to the organizational Nursing Advisory Council.


It is the desire of the professionals in the nursing division to be positive contributors to patients’ care by providing the highest quality and compassionate care to the residents of Alameda County optimizing resource use to ensure that all who desire care can obtain it regardless of their ability to pay.

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