<p>Recent years have witnessed many changes in services for learning disability clients, with concomitant changes in the role of learning disability nurses. Career pathways have expanded with the development of specialist areas of practice, such as health promotion, parenting support and family therapy, and specialist roles in, for example, epilepsy, dual diagnosis and dementia (Carlisle 1997, Pennington 2000, Mobbs et al 2002). As Wilkins (2000) observes, learning disability nurses are central to ensuring that their clients have appropriate access to health care (NHSE 1998) and, as Tait and Turner (2001) comment, are central to improving support for this client group and their families (Department of Health (DH) 2001a).</p>