Purpose: This study was a methodological research conducted to develop a clinical ladder system for operating nurses. Methods: Participants were 20 OR nurses, working in C Hospital, who had a mean tenure of 6 years and 10 months. Data collection consisted of 4 focus group interviews during May and June 2009. The content analysis method of Kim and Lee (1986) was used to analyze the data. Two clinical expert groups consisting of 16 nurses verified the content validity of the preliminary system from September 16 to 26, 2009 using Kim''s tool (1999). Results: The final clinical ladder system consisted of goals, core values, and 4 domains of practice related to core values, which were defined as professional value, perioperative nursing practice, education/research, and collaboration/leadership. Eleven nursing competencies and 44 behavior indicators were included in accordance with the 4-step ladder. The 4 operation systems for the clinical ladder system were the promotion system, continuous learning system, reward system, and support system. Conclusion: The results indicate that nursing managers need to pay more attention to developing a clinical ladder system for nurses.