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OBJECTIVE: To establish the current and predicted distribution of formal emergency nurse practitioner services in major accident and emergency departments in the United Kingdom; to determine organisational variations in service provision, with specific reference to funding, role configuration, training, and scope of clinical activity. METHODS: Postal survey of senior nurses of all major accident and emergency departments in the United Kingdom (n = 293) in May/June 1996. RESULTS: There were 274 replies (94% response rate): 98 departments (36%) provided a formal service; a further 91 departments (33%) reported definite plans to introduce a service by the end of 1996; smaller departments, under 40000 new patient attendances annually, were less likely to provide a service than busier units (p < 0.001, chi2 for trend). Three different methods of making the role operational were identified: dedicated, integrated, and rotational. Only 16 (18%) were able to provide a 24 hour service; 91 departments (93%) employed emergency nurse practitioners who had received specific training, but wide variations in length, content, and academic level were noted; 82 departments (84%) authorised nurse practitioners to order x rays independently, but only 35 (36%) allowed them to interpret radiographs; 67 (68%) permitted "over the counter" drug supplying under local protocol, and 52 (54%), "prescription only" drug supplying from an agreed list. CONCLUSIONS: Formal emergency nurse practitioner services are provided in all parts of the United Kingdom, with predicted figures suggesting a rapidly accelerating upward trend. Wide variations in service organisation, training, and scope of activity are evident.