Presented by:
· Barbra Turner, DNP, RN, FFNMRCSI , System Director, Nursing Practice and Professional Development, Bon Secours Mercy Health at ANPD 2026
· Carol Gabala, MSN, RN, RN-BC, System Director of Nursing Excellence and Outcomes at Bon Secours Mercy Health for the AHA Affinity Forum: From Data Fragmentation to Strategic Workforce Intelligence.
Clinical ladder programs are widely recognized as essential to nurse engagement, retention, and professional practice excellence— yet many remain overly manual, inconsistently applied, and difficult to sustain at scale.
CNO and NPD leaders today are challenged to modernize clinical ladders in a way that reduces administrative burden, drives meaningful nurse participation, and produces defensible data for Magnet® documentation and executive reporting.
Common challenges Bon Secours Mercy Health (BSMH) identified included:
· Heavy reliance on paper, spreadsheets, and manual review processes
· Inconsistent advancement schedules across sites
· High administrative burden for NPD teams due to variance in activities
· Limited visibility into how the ladder affected retention, quality, and Magnet® outcomes
BSMH took a deliberate approach to re‑designing the clinical ladder as a system‑wide, digitally-enabled program aligned to workforce strategy and professional practice standards.
The result was ‘GAIN’, a unified clinical ladder supported by StaffGarden, purpose‑built to simplify governance, standardize expectations, and convert professional advancement activity into actionable workforce intelligence.
GAIN delivered fast, measurable impact across retention, engagement, and financial performance. By digitizing and standardizing its clinical ladder system‑wide, BSMH was able to move beyond anecdotal evidence and clearly connect professional advancement to workforce outcomes.
· Measurable ROI and retention impact: Participation in the digital clinical ladder was directly linked to reduced nurse turnover, demonstrating avoided replacement costs of up to approximately $50,000 per retained nurse. Nurses participating in GAIN showed significantly lower turnover rates than non‑participants, validating the ladder as a data‑backed retention strategy rather than a symbolic recognition program.
· Rapid adoption and nurse engagement: Clinical ladder participation increased from less than 1% in 2024 to 14% by 2026 as digitization removed barriers to entry and created a more transparent, equitable advancement experience. GAIN proved especially effective at engaging mid‑career nurses, with the 4–5‑year tenure group—previously a high‑risk attrition population—emerging as the most active participants.
· Operational efficiency and quality alignment: Digital workflows replaced manual, paper‑based processes, significantly reducing administrative burden for NPD teams and enabling leaders to focus more time on coaching and professional development. Ladder activities were intentionally aligned with organizational priorities, resulting in over 40% of participants contributing directly to fall‑reduction initiatives and other key quality indicators.
· Enterprise visibility and long‑term scalability: Real‑time dashboards and centralized reporting provided leaders with enterprise‑wide insight into participation, turnover, tenure mix, and advancement trends. This visibility created a strong foundation for broader workforce transformation, including expansion into advanced practice roles, competencies, onboarding, and interprofessional clinical partners.
This case study examines how BSMH operationalized GAIN using practical, scalable strategies— leveraging technology to streamline workflows, engage nurses more effectively, and create a reliable data foundation to support Magnet® evidence, quality initiatives, and long‑term workforce planning.
In 2021, nursing leadership at BSMH introduced a forward‑looking strategic plan aimed at positioning the system as a destination for nursing practice. The vision was ambitious but clear: create an environment where nurses could build long, fulfilling careers at the bedside, supported by meaningful opportunities for growth, recognition, and leadership.
Three pillars shaped this strategy—advancing professional nursing excellence, strengthening the workforce, and transforming care delivery. Within this framework, it became evident that a modernized, system‑wide clinical ladder would be essential to scale across a complex, geographically dispersed workforce.
GAIN was designed to address three key stakeholder needs:
· Nurses: Clear, transparent, and equitable advancement pathways
· NPD teams: Relief from time‑intensive, manual administration
· Executives: Reliable data linking advancement to workforce and quality outcomes
GAIN was thus designed to provide a consistent advancement pathway across the entire system while still allowing nurses to demonstrate impact in ways that were locally, and personally, meaningful. Advancement criteria were aligned to organizational priorities such as quality improvement, evidence‑based practice, mentorship, leadership, and patient safety—reinforcing the idea that professional growth and organizational success are deeply interconnected. Alignment also brought transparency and greater purpose for impact to advancement activities.
As the vision for GAIN took shape, leaders quickly recognized that the program could not be sustained through manual processes.
BSMH needed a technology platform that could integrate with their existing HR platform, allow for single-sign-on (SSO) across, and be accessible anytime, anywhere, on any device. This way, Turner explained, the proposed system could actually support standardized workflows, transparent governance, and real‑time reporting across sites.
After engaging multiple stakeholders and evaluating options, BSMH selected StaffGarden to digitize and support the GAIN clinical ladder, with an eye towards expanding their usage of the digital platform to support competencies moving forward.
“We wanted to look at where we might be able to take this technology, to continue to build it and help to grow it,” Turner said, “we have to be very collaborative, and we really consider the cultural connections” of the workforce to the ladder.
StaffGarden enabled BSMH to:
· Standardize workflows across the system
· Centralize advancement and governance data
· Reduce manual effort for leaders and review boards
· Generate defensible, system‑level reporting
This decision was part of a broader shift toward strategic workforce intelligence. StaffGarden offered a way to centralize advancement data, reduce manual effort, and turn professional development activity into actionable insights.
As Gabala explained the choice of platform to host the new digital clinical ladder, she said, “the technology really, it’s just been win, win, win. There have been really no losses for us when it comes to using a technology-driven solution there.”
“We’ve had missed opportunities, but by leveraging standardized platforms integrated with HR systems, we’re creating career pathways and internal mobility,” Gabala added. “We identify talent ready to move up and create greater internal mobility rather than losing someone to a competitor.”
The team understood early on the importance of stakeholder buy-in across the organization. “We worked with local leadership and the stakeholders to begin with, what does it look like for training? What does it look like to convert?”, Turner explained.
The financial return was critical to demonstrate, with nursing leadership working with financial partners to clearly outline the return on investment from the GAIN program.
“How do we speak to our CFOs about the variance that they're going to see? How do we continue to demonstrate the return on investment?... Say that if you have X number of people in the ladder, and you retain X number of them, you pay for the ladder itself,” Turner said.
After the spreadsheets and signoffs, the education portion of the rollout would commence— Turner outlined how nurse leadership sharpened how the new ladder would look and feel in the digital platform, followed by trainings and end-user testing to ensure a smooth integration.
GAIN defines advancement not by tenure, but by impact across four consistent domains:
· Nursing culture & leadership
· Professional growth and wellbeing
· Nursing practice excellence
· Transforming care delivery
A key element of the program is the inclusion of review boards and oversight as an integral part of the structure. This reinforces transparency in decision‑making, standardized scoring and evaluation, and reduced variability between sites.
The StaffGarden platform also enables leaders to select from a list of pre-built activities the system that align to strategic priorities. This streamlines the process for leaders to align activities with organizational priorities, and for nurses to participate in meaningful activities.
The GAIN program comprises two levels: Advanced Clinical Nurse 1 (ACN1) and Advanced Clinical Nurse 2 (ACN2), for simplicity and consistency across the system. The program focuses on the NDNQI definition of “clinical”, which is, “engaged in clinical care”, explained Turner.
ACN1 focuses on participation at the unit level—participating in a unit-based council, site-based research, or a quality work project in their unit.
ACN2 is focused on leadership with impact reaching beyond the unit at the department, site, market, or even the system level. “An ACN2 might be the chair of their unit or practice council, or chair of the Quality Improvement Council for their site. Maybe they're leading an evidence-based practice project, for new surgical services at the department level. So, it's all about growth, but still keeping people at the bedside,” said Turner.
Compensation was also simplified to a bonus-based fee structure, rather than percentage-based. “We heard from our associates that they would prefer [bonus-based], and it really allowed them flexibility to go on and off the ladder without negative financial repercussion,” Turner said.
This structure allows nurses to advance while remaining in their clinical roles. “We don't always want to grow somebody from a clinical nurse to a leader or an educator. We want to continue to grow them at the bedside to keep expertise there, using our ladders to do so,” Turner added.
Instead of points, the ladder is topic-based, with a specific number of activities counting towards each goal. Turner explained that rather than incentivizing point collection, the model “focuses on the activities themselves and how they drive outcomes aligned to the Magnet framework.”
“We worked with intention to ensure that the activities within the ladder were meaningful to both the associates and the organization. We're also monitoring how activities integrate with our KPIs (Key Performance Indicators),” Turner added.
The digital clinical ladder also ensures that projects are appropriately aligned with initiatives, without oversaturating any given area.
As Turner said, “there’s only so many evidence-based practice projects you can do around falls, right? When you don't have oversight on what people in your clinical lab are doing, you're going to have a gazillion CLABSI or CAUTI projects. If we're able to see what people are working on, we can help to streamline,” by emphasizing projects that improve knowledge holistically.
The journey from vision to full enterprise rollout was strategic. Over the course of roughly three years, implementation occurred in three deliberate phases:
· Design & alignment: Stakeholder engagement, criteria definition, governance design
· Build & pilot: Configuration in StaffGarden, training, iterative refinement with consultative support from StaffGarden professional development specialists
· Enterprise rollout: System‑wide adoption, standardized review, digital reporting
The initial phase focused on extensive stakeholder engagement and alignment. Nursing leaders, NPD teams, and frontline clinicians collaborated to define advancement levels, criteria, and governance structures that would be trusted across the system. This work laid the foundation for consistency and transparency.
The build and pilot phase introduced GAIN within StaffGarden to early adopter sites. During this period, training and feedback were prioritized. Workflows were refined, expectations clarified, and governance processes strengthened based on real‑world use. This iterative approach helped build confidence in the program before system‑wide expansion.
The final phase brought enterprise rollout, transitioning the organization away from paper‑based and manual processes to a fully digital clinical ladder supported by standardized review boards and reporting.
Once GAIN was fully implemented, the impact became visible across multiple dimensions including engagement, retention, administrative time savings, ROI, and progress towards organizational initiatives.
Starting with a handful of pilot sites in April 2024, the GAIN program “immediately took off,” Turner said. “We had nurses that were enrolling who had never enrolled in the clinical lottery before, and word of mouth started to spread, and other markets said, ‘I want in’, which was neat to see because there was resistance in some markets that didn't want to convert or were nervous about it.”
Within six months, nursing teams at clinical sites across the organization were saying, “me next, me next, me next,” Turner added.
Turner explained that one site in particular, Richmond, was hesitant to adopt the new digital clinical ladder. “They loved their process, so it was a huge deviation. But once they realized they get more money with the bonus, and that it’s really cool [because of the] technology, they really started to pick it up.”
"Now, in the Richmond market— which [was already achieving] one of our highest degrees of clinical provider participation— participation has already increased,” Turner concluded.
For NPD teams and review boards, administrative burden decreased significantly, review processes became more transparent, and time previously spent tracking applications manually could be redirected toward coaching, mentoring, and program development.
For nurses, advancement pathways became clearly defined, expectations were transparent, and participation felt equitable regardless of practice location. This clarity resonated especially strongly with Gen Z nurses who value purpose, feedback, and clear career trajectories.
Importantly, the organization began to see tangible links between clinical ladder participation and quality outcomes. After the first GAIN cycle, Gabala reported that more than 40% of participating nurses were directly involved in fall‑reduction initiatives—one of BSMH’s key performance indicators. This demonstrated that professional advancement was not occurring in isolation but was actively driving improvements in patient care and safety.
At the system level, leaders gained critical visibility. By integrating advancement data into a centralized platform, BSMH could see participation trends, identify opportunities for upskilling, and tell a compelling, data‑backed story about nursing excellence, retention, and impact.
“We have everything in consolidated dashboards now, so managers are able to look and see how their unit is doing—turnover, number of new grads versus experienced staff—so it really supports decisions that are up-to-date and accurate rather than anecdotal,” Gabala added.
When the program began in 2024, BSMH had < 1% participation with GAIN. “But between 2024 and 2025, we jumped just under 3%. And then in 2026, we are now at 14%,” Turner said.
As clinical ladder participation has increased, turnover among ladder participants has steadily decreased, with retention among ladder nurses far outpacing that of non-ladder nurses.
The difference in turnover is “proof that the ladder works,” Turner said, “to engage nurses at the bedside. We’ve heard consistently on our associate engagement survey that nurses in the 2-5- and 5-10-year experience level within our organization want more opportunity to engage, develop, and participate in things. This graph demonstrates that participation.”
The nurse population that has been with BSMH for 4-5 years now has the highest ladder participation rate, a population that “we really struggled with before,” Turner added. “It’s a huge opportunity to take back to our executive leadership teams and really show the importance of the ladder.”
Importantly, this retention impact is not the result of isolated unit‑level initiatives. Because GAIN is structured as a standardized, system‑wide clinical ladder supported by a single digital platform, participation and turnover data can be evaluated consistently across sites, roles, and regions. This allows BSMH leaders to move beyond anecdotal evidence and confidently assess the impact of professional advancement on workforce stability.
For executives, these outcomes demonstrate that a modern clinical ladder is more than a recognition program.
The digital platform allows line-of-sight into previously inaccessible outcomes data. Turner emphasized the difference that level of visibility makes— “We can run these reports and take it back to our executive leadership teams and say, ‘we just saved you $50,000 with one nurse’”.
Now, the work that is happening at the associate level aligns with the leadership focus. “People are using the clinical ladder to participate in key leadership meetings and ask, ‘what are you seeing and what are you working on?’ to really get nurse feedback,” added Turner.
When implemented with clear expectations, embedded governance, and digital infrastructure, it becomes a strategic retention lever— one that connects professional development investments to measurable workforce outcomes and supports Magnet® reporting requirements with defensible, system‑level data.
These early successes have empowered BSMH to expand their use of the digital clinical ladder. Advanced practice nurses in physician practice offices now have access to GAIN, as well acute care nurses to reflect the increase in LPs in the acute care space.
“We’re starting to expand outside of nursing and into our clinical partner space, which is something unique,” Turner said.
The increase in visibility and accessibility afforded by StaffGarden’s digital platform also spurred BSMH to expand into digital competencies and onboarding.
“We're now utilizing the competency side within StaffGarden for all of our onboarding, using the TSAM process, for nursing. We're getting ready to start annual competencies, and I'm really excited that our pharmacy partners have caught on as well.”
1. The GAIN digital clinical ladder delivered measurable ROI, enabling Bon Secours Mercy Health to directly link nurse retention to avoided turnover costs— up to approximately $50,000 saved per retained nurse.
2. Digitization drove rapid adoption, increasing clinical ladder participation from less than 1% in 2024 to 14% by 2026 by removing barriers and creating a more transparent, equitable experience.
3. Nurses participating in the GAIN clinical ladder showed significantly lower turnover rates than non‑participants.
4. The program reversed attrition risk among mid‑career nurses, with the 4–5‑year tenure group— previously a high‑risk population— emerging as the most engaged participants.
5. Administrative burden reduced, as digital workflows replaced paper‑based processes and freed NPD leaders to focus on coaching and professional development.
6. Clinical ladder participation translated directly into quality outcomes, with more than 40% of participants contributing to fall‑reduction initiatives and other priority KPIs.
7. Leaders gained enterprise‑wide workforce visibility, using real‑time dashboards to track participation, turnover, tenure mix, and advancement trends for data‑driven decision‑making.
8. GAIN became a foundation for broader workforce transformation, supporting expansion into advanced practice roles, competencies, onboarding, and interprofessional clinical partners.
Clinical ladder programs are a powerful tool in driving nurse retention and job satisfaction. When designed effectively, they recognize expertise for professional growth and reinforce nurses’ value to the organization without requiring them to leave the bedside or point-of-care. To fully realize this impact, however, organizations must evolve how these programs are delivered.
By pairing a standardized, system‑wide ladder framework with StaffGarden’s digital clinical ladder platform, BSMH addressed many of the most common barriers faced by nursing leadership today: excessive manual effort, inconsistent advancement experiences, limited transparency, and fragmented reporting.
Now, BSMH empowers nurses with a seamless, efficient and rewarding path for advancement by modernizing the clinical ladder. BSMH’s journey highlights how purpose‑built digital solutions like StaffGarden can help nursing leaders move beyond program management and toward measurable, sustainable impact.
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