Integrated care at the bedside: job description consensus.

A Nursing Career Pathway Committee developed a differentiated nursing model based upon the Midwest Alliance in Nursing competencies. Two distinct and complementary roles provide direct nursing care: the Registered Nurse in the Associate Role and the Registered Nurse in the Primary Role. Through a differentiated nursing demonstration project, the need for changes in the "charge nurse" role became apparent. Opportunities for growth and participation, regardless of position held, are presented. Agencies without "clinical ladders" will be intrigued with this fresh approach for rewarding nurses who provide direct care.