This article presents the findings of a local initiative to develop practice standards for patient handling in a specialist orthopaedic hospital. The changes in practice needed were first, to implement the statutory minimum standards for load handling (HSE 1992a); second, to minimise the high risk of injury, particularly to the back, faced by nurses mobilising patients; and third to meet the need for an instrument which could be used in developing and evaluating better clinical conditions for patients and working conditions for nursing staff. Participants reached a level of consensus over a broad range of standards, but even after three rounds, consensus on four standards was not reached. The author suggests this type of study can be used to develop standards applicable on a local level.