Aim A service review of a secondary care advanced nurse practitioner-led service. Background An acute hospital-based elderly care rehabilitation service evolved over a 9-year period from a traditional consultant/junior doctor configuration to a consultant/advanced nurse practitioner configuration. The review evaluated the advanced nurse practitioner team's role in the clinical setting, and the constraints experienced as a result of the traditions of the hospital organization. Evaluation The review drew its conclusions from opinion data collected from 38 professionals and non-professionals within the rehabilitation service. Key issues The organizational infrastructure and traditions that had an impact on service delivery by the advanced nurse practitioner team. There is a demand for senior management to act on developmental constraints. Conclusions The advanced nurse practitioner-led rehabilitation service was fit for purpose and an emerging model of a non-medical led care. However, important organizational constraints were identified. Implications for nursing management An advanced nurse practitioner team, working in collaboration with medical consultants, was a model for future service redesign in the acute hospital setting. Nevertheless, it presented challenges to senior health-care managers on current organizational infrastructures.