Most frontline workers do not earn enough to support a family, many have less than a bachelor's-level education, and almost all lack credentials that make significant advancement possible. Their formal training often is limited; instead, they learn their jobs from peers and through “trial and error” experiences that may be valuable—but that also may limit the quality of care they provide and their chances to advance

The costs to employers are high as well, including the lost potential for delivering the best care possible and the turnover among frontline workers. High turnover disrupts continuity of care, and it is expensive to train replacement employees, even at the entry level.

If healthcare employers are to remain competitive, their business models must address high turnover rates and the lack of advancement opportunities among frontline workers. In other words, improving healthcare requires finding ways to efficiently and effectively upgrade the skills and advancement opportunities of frontline workers.

Career ladders provide multiple avenues out of low-skill, low-wage jobs and into family-sustaining/skilled occupations. Successful career ladders can financially benefit an employer organization's members by lowering turnover and recruitment costs.