A New Clinical Ladder for Advanced Practitioners Improves Retention, Engagement

Five years after implementing a “clinical ladder” for advanced practitioners (APs), Moffitt Cancer Center reports higher AP retention and recruitment rates, as well as greater recognition of APs, throughout the center. The findings were presented by Sara M. Tinsley-Vance, PhD, APRN, AOCN, from Moffitt Cancer Center in Tampa, Florida, at JADPRO Live Virtual 2021.

Practitioners at Moffitt Cancer Center developed the clinical ladder between 2015 and 2016, after identifying a need to improve retention, recruitment, and job satisfaction of APs.

To fill this need, a team of APs (including the director of AP services) met to develop a professional clinical ladder that prioritizes creating a respectful, diverse workplace culture and models that ensure high-quality patient care, research, and education.

The ladder consists of four levels based on: minimum eligibility criteria, years of AP experience, and years of experience at Moffitt in specialty. The ladder outlined monetary awards for progressing to the next level, with mentors meeting biannually to discuss whether the next level had been reached:

  • Level 1: no monetary award
  • Level 2: $3,000 annually
  • Level 3: $6,000 annually
  • Level 4: $9,000 annually

The ladder was implemented in 2016. In its first year, 23 of 109 eligible APs participated (21%). The program continued to grow, with 117 of 269 eligible APs participating in 2020 (43%). When asked about their reasons for participating in the ladder program, APs ranked “opportunity to be involved at Moffitt” and “recognition” as their top concerns.

According to Dr. Tinsley-Vance and researchers, in the five years since its implementation, the APP clinical ladder has been successful in decreasing turnover rate – from 10% in 2016 to 4.7% in 2020 – and improving engagement rate – from 4.03 to 4.27.

The researchers also described increases in the number of APs employed by the center. For example, in 2017, the center employed 209 APs; that number jumped to 342 in 2021. The number of advanced registered nurse practitioners increased most substantially, from 102 to 187.

“The AP clinical ladder is a proven tool used for recognition, retention, and recruitment of APs,” the researchers concluded. Notably, “retention has improved over the five years since its inception, primarily in APs remaining within their specialty, which promotes expertise within their various disease states.” Dr. Tinsley-Vance and authors noted that, based on these five-year results, “our committee recommends utilization of an AP clinical ladder for healthcare facilities that employ nurse practitioners, physician assistants, certified registered nurse anesthetist, and anesthesiologist assistants.”

The authors report no relevant conflicts of interest.


Tinsley-Vance SM, Valone T, Adams M, et al. The advanced practice professional ladder: looking back over 5 years of climbing. Poster JL918. Presented at JADPRO Live Virtual, October 7-17, 2021.