Changes in the health care system are necessitating new approaches to acute care delivery. The acute care nurse practitioner (NP) role was implemented in the cardiothoracic intensive care unit (CVICU) at the University of Alberta Hospital, Edmonton, Alberta. An evaluation of the structure, process, and outcomes of this new role are presented. A survey was conducted of all health care providers (n = 90) directly involved with the NP in the CVICU. The unique skills of the NP were perceived to have a beneficial impact on patients and families, nurses, physicians and other health care providers. Factors affecting the implementation of the NP role in CVICU are described.