Keep in mind that liberals want to unionize all health care workers. So, even if there might not be room for promotions, it would work like teachers where they get increases in salary based on seniority.
For all intents and purposes that’s how it works for most of them anyway. Maybe a little bit of merit but mostly the raises are just COLA. When you have a stratified power structure with extremely low turnover there’s not much room for true merit raises, true merit raises would result in nurses that have been with you a long time making “supervisor” money even though they have the same title and responsibilities as inbound rookies. A step and ladder system, as annoying as they are, might actually help because it would put levels between rookie and floor supervisor. Having a level system helps break up the work force into income strata, not really sure how health care has resisted that for so long, I know it makes it cheaper for the business but you’d figure there’d have been an employee revolt or two already.