This article explores the issue of retention of occupational therapists and its impact on the facility, client, department and the profession. It also describes the use of a clinical ladder as a retention tool and presents the experience of one clinical facility in developing a clinical ladder. The literature, in association with the experience of the aforementioned clinical facility in the development of a clinical ladder in an occupational therapy department, does not provide conclusive evidence of the efficacy of a clinical ladder as a retention tool. However, it does lend enough support for the concept to encourage its further use in occupational therapy departments. There is a need to be creative in the design of retention methodologies which will decrease turn over and attrition from the profession in order to provide a stable pool of personnel to agencies that employ occupational therapists.