This paper discusses the introduction of a 24-h nurse practitioner service in a major accident and emergency department and monitors it over a 3-month period. The paper provides a description of the activities of the nurse practitioners and a critical evaluation of their role. It shows that every major accident and emergency department can set up a 24-h nurse practitioner scheme and the organization of such a scheme can be very simple. This is the first article to look at a 24-h service.