Development of healthcare in Ireland, including its structures and delivery of care, is driven by the safety and quality agenda that has become increasingly explicit in the last ten years (Department of Health and Children 2008). Nurses and midwives have contributed and continue to contribute to the enhancement of patient care and this contribution can be captured and articulated by focusing on their clinical outcomes. The National Council for the Professional Development of Nursing and Midwifery has provided focused guidance on measuring clinical outcomes in its discussion paper Clinical Outcomes (National Council 2010a). Building on that guidance, the present discussion paper has been developed as a resource for clinical nurse/midwife specialists (CNSs/CMSs) and advanced nurse/midwife practitioners (ANPs/AMPs) wishing to articulate and clarify their contribution to patient care. The need for this specialised guidance emerged from a recent evaluation of CNSs’/CMSs’ and ANPs’/AMPs’ clinical outcomes, and the final report on the evaluation contains a recommendation concerning the development of key performance indicators relevant to the roles of these nurses and midwives.