The clinical ladder program has evolved with the ever-changing environment of nursing at one academic medical center. The process has developed over time while adhering to the foundational tenets of recognizing and rewarding excellent bedside nursing practice. Nurses on the clinical ladder at this institution represent the ideal performance of mentoring and motivating other nurses and interdisciplinary team members. This article describes how the program has evolved over the last two decades, the challenges that have been met, and the successful outcomes that endure.