National guidance in the United Kingdom on the provision of services for children and young people with cancer and their families has consistently emphasised the need for specialist nursing as central to the delivery of safe and effective care. The temptation when examining the role of the specialist nurse is to look at those posts that carry a recognised 'specialist' label. It is equally important, however, to look at the development of nursing practice across the speciality and at how this can be both supported and recognised. Nurses with specialist knowledge, skills and expertise in paediatric oncology are needed in positions where they are able to develop nursing practice, direct service development, lead nursing research, and guide education and training. Effective clinical leadership is essential at the point at which nursing care is delivered whether that is at the hospital bedside, in the clinic and day care unit, or in the family home.