Aim. This paper reports a study exploring issues arising from the introduction of innovative nursing and midwifery roles from the perspective of healthcare managers.Background. In recent years, the number of innovative roles in nursing and midwifery has increased dramatically across all areas of health care. A comprehensive literature review has shown that there is a scarcity of empirical studies to inform policy or the organizational context of this rapidly changing situation.Method. Semi-structured interviews were conducted with all Directors of Nursing, Chief Nurses and Directors of Primary Care in the Health and Social Services Trusts and Boards in Northern Ireland. This study formed the first phase of a larger exploration of innovative roles. Data were collected from July to October 2004.Findings. The findings confirm that in recent years there has been a considerable increase in the number and type of innovative nursing and midwifery roles. Themes that emerged from the data included professional identity and number of innovative roles; stimuli for role development; service commissioning; infrastructure support; and perceived value for money.Conclusion. Analysis of the impact of innovative nursing and midwifery roles on other members of staff, notably healthcare assistants, is needed. The internationally increasing number of innovative roles need to be evaluated further with regard to their effect on care outcomes for patients, their families and communities, their cost-effectiveness and to how best to secure the support and commitment of colleagues. Further study should also be undertaken to determine whether innovative role-holders are pioneers in the development of future nursing, or whether they are responding to the workforce needs of the medical profession or to the requirements of the health service to cut costs.