Over the past few years, emergency nursing has introduced new roles to allow nurses to practise at advanced levels. The well established emergency nurse practitioner role, which focuses on patients with minor illnesses and injuries, is being expanded and remodelled, partly to fill the gap created by the decline in the number of emergency medicine doctors. One emergency department in Scotland has introduced an extended nursing role called the acute nurse practitioner, which enables nurses to work at an extended level in the majors area of the department. This article discusses findings from a study that examined a range of healthcare clinicians’ perceptions of this newly established service. Findings suggest that the service is received positively by colleagues and patients, but also highlight a number of issues that need to be addressed to enhance the service and support implementation in other emergency departments.