社會變遷醫療經營型態快速變革，民眾對醫療、護理服務品質之要求日益高漲，護理人員之專業能力影響病人與家屬對醫療服務之滿意度，如何因應此急遽變革為行政管理者之重大挑戰。美國護理界於1970年代發展臨床分級制度以提昇護理專業能力，國內於民國77年起經由衛生主管機關及護理界之推動，各醫療機構也紛紛發展適用之臨床專業能力進階制度，期使經由此制度有計劃的訓練在職各級護理人員，提昇臨床護理人員之專業知能，提高護理服務品質，穩定護理組織與結構。本文藉由醫學中心發展臨床專業能力進階制度、成效探討與未來展望提出經驗分享，期望能拋磚引玉呼籲護理同業建立進階制度之共識，匡正主客觀之分級界定，以使護理人員能依尋能力分級標準與國際護理專業發展接軌。

　　　　　As the social and economical environments improve, the demand for higher level of medical and nursing care raises. The nursing specialty affects the level of nursing care significantly. In 1970, the American Nursing Society set up their clinical ladder system to improve knowledge and ability in nursing specialty, with impressive results. In 1992, we set up our clinical ladder system in the Nursing Department of Taipei Veterans General Hospital and all nursing personnel were enrolled in this system. This article reports the progress of our clinical ladder system and evaluates the effect of this system. It is shown that this system was very effective in improving knowledge and ability in nursing specialty, and the improved nursing skills made our nursing care more efficient and more qualified. Thus, we recommend to set up a clinical ladder system in every medical center to foster common decision-making, to enrich the practice environment, and to improve the way for international connection.