Aim This research was designed to evaluate innovative roles underpinning successful nurse-led services in nursing and midwifery in Scotland.

Method A dual methodological approach encompassing a national survey and detailed case studies was adopted. The survey of all NHS trusts in Scotland was designed to profile role developments and extended practices in nursing and midwifery practice. The survey data were used to identify case studies that reflected innovative roles within nursing and midwifery. Twenty semi-structured interviews were undertaken with clinical nurse specialists and analysed using the constant comparative approach of grounded theory.

Results Three case studies in acute care were identified for in-depth study. The key themes to emerge were the specific nature of the work, the professional merit associated with each role, benefits to patients and the importance of objective evaluation of the role.

Conclusion The findings from the acute care case studies strongly support the importance of nurses promoting and developing patient-focused initiatives in acute care.