This article describes the change processes involved in developing an orthopaedic nurse practitioner (ONP) role within an outpatient and pre-admission assessment clinic setting in the United Kingdom. The first year of the project - the Orthopaedic Patient Care in the Outpatient Setting (OPCOS) Project - is examined and the successes and lessons to be learned identified.So often we read about the end result of changes within orthopaedic nursing and are led to wonder how these changes were achieved. This article describes an organised and sustained approach to change, which is necessary if change is to be embedded and for the better.