The United States spends more than other high-income countries on health care, while continuing to lag behind in quality, access, life expectancy, and care coordination. Patient populations and where they receive care is changing drastically, with volumes shifting from the inpatient, episode-centered model to an outpatient, health promotion centered model. Ambulatory care nurses are uniquely positioned within the healthcare continuum to lead the transformation of care for diverse patient populations. One strategy that enables the ambulatory care nurse to practice all dimensions of his or her specialty role is the development of a clinical advancement system(CAS). CAS, or clinical ladders, are one strategy that can assist nurses in acquiring skills necessary to support excellent practice as well as improve quality patient care outcomes.