Rationale: The number of innovative roles in nursing and midwifery has expanded considerably; however, the evidence base for the introduction of these roles is limited.Aim: This study aimed to identify the managerial and developmental issues affecting those in innovative roles.Methodological design: A self-completion postal questionnaire was distributed to all innovative role holders in Northern Ireland, 450 responses were analysed. This survey was the second phase of a larger investigation into innovative roles in nursing and midwifery.Instrument: The questionnaire that had been developed for the 'Exploring New Roles in Practice' project was adapted for use in this study.Ethical issues: The explanatory letter sent to potential participants clearly detailed that informed consent was assumed on receipt of a completed questionnaire and gave contact details for the research team. The confidentiality and anonymity of responses were assured.Results: Most participants (65%) stated that their innovative role had commenced since the year 2000. There was evidence of preparation for these roles including the development of job descriptions and protocols. Nevertheless, there were issues noted relating to resource allocation and replacement when the role holder was absent. The importance of role evaluation was highlighted, with some participants noting their role had not been assessed since its inception. Support provided by managers and colleagues was key to ensuring role effectiveness. Participants reported high levels of job satisfaction.Limitations: Innovative role holders were identified by managers in their employing organization: therefore the research team could not verify that all existing innovative roles were included in the study. Innovative roles in private and voluntary sectors were not included.Conclusions: The evolution of innovative nursing and midwifery roles has been considerable worldwide and they engender job satisfaction to those occupants them. Results support international literature showing that adequate support, especially from administrators, is significant to ensuring the success of new roles. Furthermore, the careful planning for innovative role development and evaluation are important in ensuring the role is effective.