A points-based career ladder that rewards certifications, extra duties and community service has helped Deerfield, Ill.-based SCA Health cut front-line nurse turnover by 7%.”
Dare Meeks, RN, SCA Health’s chief nursing officer, joined Becker’s to discuss the ASC company’s registered nurse clinical ladder program — a five-level, points-based system that launched formally in 2024 — and what it’s meant for retention across the company’s roughly 350 surgery centers.
“We spent a lot of time doing research ahead of that pilot to format a way that our front-line nurses who are not seeking leadership roles could advance professionally — as a retention tool, and also a way to affirm how amazing our nurses are,” Ms. Meeks said.
How it works
Points are awarded for a range of accomplishments: years of experience, education level and additional degrees or certifications such as a BSN, MSN or CNOR. Nurses can also earn points for taking on additional duties, such as resource nurse, specialty nurse, education nurse, infection control preventionist or quality nurse.
“In the ASC industry, and in our organization, those tend to be additional duties as assigned for a staff nurse who wants to do more and wants to contribute, but they don’t necessarily receive additional compensation for that work,” Ms. Meeks said. “So this is a real way that we can affirm and recognize those front-line nurses who take on that additional work, which is critical to our success in every one of our surgery centers.”
Points are also available for coordinating, leading or serving in community service or surgical mission trips, aiming to recognize nurses’ contributions beyond the facility’s four walls.
Nurses submit an application to a review committee, and those who advance receive a pin, a personalized letter from Ms. Meeks, and recognition across the organization. They also receive a compensation review and an opportunity for additional pay based on their advancement level, determined by what Ms. Meeks describes as a “very specific algorithm” supported by HR and leadership.
The annual application period opens May 1, with a 30-day window to apply. Compensation changes, if any, are published in mid-July, around 60 days after the application period closes.
“It’s really designed to drive engagement with the organization — service within the organization as a means of professional growth and development,” Ms. Meeks said.
The results
The response has been strong. About 10% of SCA Health’s enterprise RN team, roughly 320 nurses, applied in the first cycle in 2024. Participation grew to around 12%, or approximately 370 nurses, in 2025. The current application period, which opened May 1, will show whether that momentum continues.
“Our facility leaders and directors of nursing encourage participation and can leverage it as a way to educate frontline team members who are seeking growth,” Ms. Meeks said.
The clinical ladder is one piece of a broader retention push that has contributed to a roughly 7% decrease in front-line nurse turnover. This is significant at a moment when more than 40% of nurses nationally are expected to exit the workforce within the next few years, according to the 2024 National Nursing Workforce Study.
“The importance of investing in all nurses, and particularly giving our earlier-career nurses the opportunity to really engage and grow and see that potential for growth, drives retention,” she said. “We see in our younger, earlier-career team members a real difference in the way they look at longevity in any particular organization, and that causes us to double down on how we think about retaining and engaging our team members.”
Why it fits in the ASC setting
The program is particularly well-suited to the ASC environment, Ms. Meeks said, where leaner teams mean nurses are closer to every aspect of how a facility operates.
“We do tend to see longer tenure in our surgery centers for nurses, and they have so much exposure to all aspects of the operation, because it’s right there front and center in a smaller facility with a smaller team,” she said. “There’s more access and exposure to senior decisions, whether that’s adding another service line, investing in a large piece of equipment, or bringing in new partners to begin performing procedures.”
That proximity to decision-making is intentional at SCA Health. The organization operates under a high-reliability framework, Ms. Meeks said, one principle of which is deference to expertise — prioritizing input from those closest to the point of care.
“That’s a unique opportunity for nurses in the ASC setting to be strong contributors,” she said. “And we know that when we defer to expertise, the outcome of the decision and the success of the initiative is always better than when we don’t listen to those stakeholders.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
