The modern development of specialist nurses started in the early 1970s. This article provides a brief history of their evolution and in particular outlines some of the key factors in their emergence as a key care provider in health care today. There is a constant threat that their clinical nursing background and key nursing skills will be sacrificed or substituted by a more medical-oriented approach. The future, therefore, is one of striking the right balance between nursing and medicine sub-specialism and holistic patient care.