<p>Few nursing roles have been subjected to the level of scrutiny as that of the nurse practitioner (NP). While research evidence shows that NPs in emergency care settings are at least as clinically effective as their medical colleagues (Mabrook and Dale 1998, Freij et al 1996), few of these studies have demonstrated the added value that nurses bring to this role, thereby reinforcing the argument that it is predominantly one of medical substitution.</p>