Purpose: To evaluate nurses' reasons for joining a clinical ladder program, their experiences during participation, and how they use their new competence in practice.
Design and methods: Cross-sectional survey design. Sample was 541 nurses who participated in clinical ladder programs at four hospitals in Norway. Data were analysed with descriptive and inferential statistics.
Findings and conclusions: Internal motivational factors were most important reasons for joining a clinical ladder. Nursing leaders were lacking in their engagement with the clinical ladder project and its participants. Perceived learning effect, use of competence, and intent to stay increased as nurses progressed in the ladder.