The Institute of Medicine (IOM) landmark report The Future of Nursing: Leading Change, Advancing Health emphasizes the critical role of nurse leaders in redesigning health care and preparing nurses to lead (IOM, 2011; Altman, Butler & Shern, 2016). Swan and Moye (2009) reiterate the importance of ambulatory care succession planning that includes identifying and developing emerging leaders. Nursing must evaluate strategies to advance leadership as a dimension of practice and as part of lifelong learning (Scott & Miles, 2013). Significant gaps remain in understanding nurse leader and aspiring leader roles, practice, perceptions, and succession planning in the ambulatory care setting. This exploratory descriptive research design involved a nationwide convenience sample of American Academy of Ambulatory Care Nursing (AAACN) members. A one-time web-based survey was conducted between April and May 2017. Current leader respondents were well educated, sought their roles, were confident in their leadership, felt they could influence nursing’s visibility and leadership status, and were willing to mentor. Aspiring leaders were generally younger and also well educated, but were less confident and less likely to have taken leadership development courses or know of leadership resources. Neither group was diverse. Aspiring leaders saw lack of advancement opportunities and accessible leadership education. Few organizations had succession plans in place. Both leaders and aspiring leaders reported low involvement in health policy. Communication, leading change, and knowledge of the health care environment were identified as priority leadership competencies necessary for success. Action is needed to develop younger and more diverse leaders in key competency areas. Ambulatory care nurses also must take steps to increase their visibility and policy making influence, and communicate nurse value as the health care environment transforms.