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The time and spatial constraints of face-to-face learning often affect nursing staff’s inclination to enroll in ladder system training classes. Hence, their competence in clinical care may be unable to meet the requirements of the hospitals they work at. The e-learning mechanism offers a way to overcome such constraints. However, the differences in learners’ achievement and satisfaction between traditional face-to-face and non-synchronized e-learning classes in the nursing clinical ladder system have not been thoroughly investigated. In this study, 155 nursing personnel serving at the case hospital, enrolled in N1/N2 ladder courses, were invited to participate as the subjects. The results showed that those who attended face-to-face learning classes reported higher satisfaction but achieved less in class than those in the e-learning class. The factors which influence the subjects’ satisfaction with e-learning were investigated and summarized.

Nursing projects are a key part of N4 professional competency training for nursing personnel. Low passage rates for these projects have been shown to negatively affect the intent of nursing personnel to advance further in the nursing ladder system. This study analyzes the scores for nursing projects between 2011 and 2013, the passage rate for these projects, and the differences in passage rates between different types of projects. This retrospective and descriptive study collected data on nursing projects conducted under the auspices of the Taiwan Nurses Association between 2011 and 2013. Furthermore, the comments of reviewers on 100 nursing projects were randomly selected and subjected to content analysis. A total of 3,359 nursing projects were examined. Eliminating unqualified nursing projects left a total of 3,246 projects for the dataset. A total of 1,099 projects were scored with passing grades, giving a passing rate of 33.9%. The authors of these passing projects worked primarily in northern Taiwan, wor

背景　護理專案是護理人員進階N4的重點專業能力訓練，因通過率低而影響護理人員進階之意願。目的　本研究之目的在於分析2011至2013年護理專案的得分概況；並比較護理專案是否通過與專案屬性之差異性。方法　採回顧性描述性研究，收集2011至2013年台灣護理學會護理專案資料庫之資料作分析。並隨機抽樣100篇護理專案之審查委員意見作內容分析。結果　2011-2013年共有3,359篇護理專案送審，排除不符合規定之護理專案後共有3,246篇，通過篇數1,099篇，通過率為33.9%；護理專案送審作者所服務醫院之地理分佈以北部、醫學中心、重症科別最多；平均得分及通過率以中部最高，離島最低。送審主題以「護理服務技術或品質之改進」類最多（77.3%），得分比率最低的評分項目是問題及導因確立、現況分析、結果評值。護理專案主題與是否通過無統計上顯著差異；但在年度、送審醫院地理分布、機構層級、科別等皆有統計上顯著差異。在抽樣100篇中，其審查委員意見之內容分析結果顯示：正向意見最多的項目是文獻查證與參考資料；負向意見最多的項目依序是文獻查證與參考資料、現況分析、解決辦法及執行過程、結果評值、問題及導因確立。結論／實務應用　本研究分析護理專案之屬性、送審趨勢及審查委員意見，在撰寫專案時問題及導因確立、現況分析、結果評值等是待加強項目。研究結果可提供護理人員執行專案之參考，及作為推動「護理人員臨床專業能力進階制度」變革與決策之依據。

The professional nursing competence ladder system can effectively inspire nurses’ work morale, improve quality of life, and avoid the issue of senior staff leaving the clinical setting. The aim of this study was to explore the willingness to participate in the professional nursing competence ladder system and its related factors among nurses. A cross-sectional study design with a structured questionnaire was used. Purposive sampling was employed, and 696 nurses who qualified to be promoted as N2 were recruited from a medical center in southern Taiwan. The results showed most nurses were willing to participate in the nursing ladder system. There were significant differences between willingness to participate in the ladder system and age, education level, as well as promotion experience. This study emphasizes the importance of intensifying internal encouraging factors and strengthening external encouraging factors to improve participation rates. Healthcare institutions could provide instruction on case report writing to increase nurses’ willingness to participate in the clinical ladder program.

This article explores the issue of retention of occupational therapists and its impact on the facility, client, department and the profession. It also describes the use of a clinical ladder as a retention tool and presents the experience of one clinical facility in developing a clinical ladder. The literature, in association with the experience of the aforementioned clinical facility in the development of a clinical ladder in an occupational therapy department, does not provide conclusive evidence of the efficacy of a clinical ladder as a retention tool. However, it does lend enough support for the concept to encourage its further use in occupational therapy departments. There is a need to be creative in the design of retention methodologies which will decrease turn over and attrition from the profession in order to provide a stable pool of personnel to agencies that employ occupational therapists.