The organisation and delivery of critical care services have come under scrutiny in recent years with media attention focusing on a shortage of intensive care beds and a lack of appropriately trained nurses to staff them (Wright 2000). The provision of these services is under review nationally, prompting a new approach to the organisation of intensive care and high dependency beds (DoH 2000, Scottish Executive 2000). In Lanarkshire in the specialties of ear, nose and throat (ENT) and maxillofacial surgery, access to these facilities was restricted and not always available or appropriate for these patients’ needs. This article illustrates how nurses brought about real change by proposing a possible solution to establish two step-down beds in the ward. Establishing these beds not only provided many benefits for patients, but also gave nurses the opportunity to gain advanced skills and ultimately increased job satisfaction.