Incorporating organizational, departmental, and professional visions of clinical ladder development en- sured necessary administration support. Administration assisted in revising job descriptions and performance review criteria and developed appropriate financial in- centives. Review of the American Association of Oc- cupational Health Nurses, Inc. (AAOHN) Professional Practice Standards and Competencies (Sidebar) resulted in clinical ladder language being used that was accepted by occupational health nurses’ professional organiza- tion. Because of the collaborative nature of the clinical ladder development process and the chaos associated with the development and implementation of a new tool, the staff needed support.