Health systems are modernizing career advancement programs to build internal pipelines and keep nurses at the bedside.

These programs are being updated to better recognize clinical expertise and support professional growth without requiring nurses to leave direct patient care. Altamonte Springs, Fla.-based AdventHealth, for example, launched a four-level clinical ladder in 2022. Since then, half of its 23,000 eligible nurses have enrolled, and the system credits the program with helping avoid $47.5 million in turnover costs in 2024.

“Historically, to advance, nurses often felt they had to step away from the bedside because those roles didn’t fully recognize the specialized competencies they bring,” Trish Celano, MSN, RN, system chief nurse executive for the system, told Becker’s in October. “The clinical ladder changes that.”

Five chief nursing officers shared with Becker’s how their own programs have evolved and what results they are seeing.

Tamera Dunseth Rosenbaum, DNP, RN. Chief Nursing Executive at UCHealth (Aurora, Colo.): UCHealth measures ROI for its nurse advancement programs through a combination of retention rates, internal mobility, engagement scores and cost savings from reduced turnover, as well as qualitative feedback from nursing staff and their managers.

For experienced nurses, UCHealth’s professional practice and recognition program, UEXCEL, has supported professional growth for more than 30 years. In July 2025, UCHealth launched UEXCEL NextGen to simplify processes and better align with nurses’ career aspirations. The updated program expands options for demonstrating growth in clinical practice, education, evidence-based practice and leadership. While it’s early to report quantitative outcomes for NextGen, initial feedback has been positive and participation rates in the first cohort exceeded expectations.

For aspiring nurses, the Ascend Career Program helps current UCHealth employees to grow their careers in healthcare through tuition reimbursement and funded educational opportunities. More than 6,600 staff members are taking part, seeking degrees and certifications in a variety of areas, including nursing, behavioral health, public health administration, radiology, respiratory therapy and more. There is high demand for nursing degrees among staff, and the first cohort of nursing students graduated with BSN degrees in August 2025. More nursing programs have been added and could result in nearly 200 nurses graduating with degrees by 2030.

Regina Foley, PhD, RN. Chief Nursing Executive and President of Specialty Hospitals and Clinical Services at Hackensack Meridian Health (Edison, N.J.): At Hackensack Meridian Health, we measure the ROI of our nurse advancement programs through key performance indicators like retention, recruitment pipeline health and vacancy rates. The most significant outcome to date is achieving a low 4% nurse vacancy rate, a 2.5% decrease from last year, which we attribute to a multi-pronged approach. Our 4% nurse vacancy rate is nearly 60% below the national nurse vacancy average.

To build our talent pipeline, we’ve implemented several successful initiatives. Our ABSN Employment Bonus Program, which offers up to $35,000 for a three-year commitment, is constantly growing. Similarly, our OFFER program (ongoing support, financial assistance, flexible schedules, educational counseling, RN mentors) for Patient Care Technicians supports them through nursing school with flexible paid schedules and has 153 current participants. Our RN CAP program provides a formal ladder for advancement, rewarding clinical expertise at the bedside and improving job satisfaction.

These positive outcomes are shaping our strategy to evolve from a series of programs into a comprehensive and sustainable nursing ecosystem. The success of our current initiatives validates our continued investment, which includes providing around $350k in annual nursing scholarships and partnering with three local nursing schools to strengthen our educational pipeline. We are leaning into proven retention drivers, such as our referral program, which results in new hires who stay for an average of five years or more. Looking forward, we are also in the process of expanding innovative models of care, like our hugely successful virtual nursing program that now covers 147 beds.

By investing heavily in our team members through professional development, internal promotion, and financial support, we have cultivated strong brand loyalty and have the evidence to show our commitment is delivering a powerful return.

Denise Ray, BSN, RN. Chief Nursing Executive at Piedmont Healthcare (Atlanta): Piedmont has a multi-pronged approach to recruitment, retention and nurse satisfaction and how we measure return on investment. We have historically had clinical ladders, and we provide a financial incentive of $3,750 for nurses who complete them. However, that is a small piece of how we determine ROI regarding our retention goals.

We have focused on making sure that we are providing good mentorship through our training residency program for new nurses. Of the 1,291 residents who came through our system in FY 2025, we have a retention rate of 96% — thanks to the residency program, which recently received ANCC accreditation. Based on our low attrition rate through that program, we estimate an ROI of $16 million over the past two years (based on data from the Advisory Board regarding the average cost to replace one staff RN).

Another less direct ROI measure we use regarding retention is through our virtual nursing program. Since launching it in September 2024, Piedmont’s Virtual Nursing Program has improved quality, efficiency, and satisfaction across the system — saving 84,460 hours on discharges alone (not counting hours devoted to admissions and medication reconciliation) that were reinvested back into direct patient care. Eighty-five percent of nurses report loving the program, and 78% say it makes them more likely to stay at Piedmont. This program leads to greater efficiency, greater nurse satisfaction and, as a result, greater retention.

Mandy Richards, DNP, RN. Chief Nursing Executive at Intermountain Health and President of Intermountain Children’s Health (Salt Lake City): When our nurses told us they wanted to grow at the bedside, rather than leave it, we listened. Together, with front-line nurses and educators, we created iAspire, a program that fosters clinical excellence, professional growth and career advancement within direct patient care.

Through iAspire, both new graduates and experienced nurses can refine their expertise, expand their skills, and continue providing exceptional care at the bedside. Early results show stronger engagement and improved retention. This is proof that when we build programs with nurses, for nurses, everyone benefits, especially our patients.

Gail Vozzella, DNP, RN. Senior Vice President and Chief Nurse Executive at Houston Methodist: The Houston Methodist Clinical Career Path (CCP) was established in 2007 to recognize and support the growth of nurses who provide exceptional bedside care. This four-level advancement program is grounded in Benner’s model of novice to expert and emphasizes clinical excellence, professionalism and meaningful contributions to nursing practice.

In 2022, we collaborated with a dedicated group of Houston Methodist frontline nurse leaders and staff to re-evaluate the CCP. Our efforts were driven by a shared commitment to ensuring the program continues to reflect the evolving needs of our nursing workforce.

Through this collaborative effort, opportunities were identified to enhance consistency across campuses, strengthen system-wide nursing governance and update criteria to align with current practice environments.

With strong engagement from nursing teams and support from executive leadership, the CCP further empowers nurses and recognizes their invaluable contributions to patient care, their units and hospitals, and our larger community. As part of this enhancement, compensation structures were thoughtfully adjusted to reflect the impact and expertise of our nurses.

Our nursing educators provided comprehensive education on the updated CCP across the system to ensure understanding and adoption. Houston Methodist remains committed to ongoing evaluation of the program, with biannual reviews. This ensures we continue to meet the needs of our nurses and they feel supported and empowered as they deliver unparalleled care to our patients.

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