It is ten years since the Commission on Nursing recommended in 1998 the development of a clinical career pathway for nurses and midwives in Ireland. The National Council for the Professional Development of Nursing and Midwifery established the first Irish frameworks for role development for clinical nurse and midwife specialists (CNS/CMSs) and advanced nurse and midwife practitioners (ANP/AMPs) in 2001. Almost two thousand clinical nurse and midwife specialist and over one hundred advanced nurse and midwife practitioner posts have been developed to date. These posts have been developed in line with service needs and in the interest of quality, integrated patient/client care. A multi disciplinary approach to role development based on service needs analysis was utilised. These roles have received strong medical, multi disciplinary and management support which has been essential in their successful development and implementation. Experienced, highly qualified nurses and midwives now have the opportunity to remain in clinical practice providing expert care within a clinical career pathway. This means that nursing and midwifery skills and competencies are being used appropriately within the health care system to provide high quality, patient focused care.