The Implementation of a Clinical Ladder in Rural Japanese Nursing Education: Effectiveness and Challenges.

The clinical ladder is an essential tool for nursing education, enabling nurses to ascend from novice to expert. The learning content for nurses can depend on their clinical situations. The aging of societies has changed the demand for nurses at community hospitals because of the multimorbidity of older patients. At the same time, the gap in nursing education between urban and rural hospitals is wide, as rural hospitals often lack the application of the clinical ladder. This study investigates the effectiveness of using the clinical ladder in a rural Japanese community hospital using the clinical ladder scale and interviews. Through its application, we found that both novice nurses and nursing educators came to recognize the effectiveness and importance of the ladder. However, unfamiliarity with assessments, working conditions, and Japanese culture inhibited the smooth application of the ladder. For the effective application of the clinical ladder, continual training on assessments and the ladder's effectiveness in clinical situations, along with consideration of educational background, should be enhanced through the monitoring of the clinical ladder.