Background: The increased incidence of chronic disease in recent years represents a significant challenge for the National Health Service. This coupled with substantial reforms in recent years has resulted in many changes in the delivery of healthcare, such as the proliferation of new nursing and midwifery roles. One such role is the Respiratory Nurse Specialist. Aims: The aim of this paper is to explore the role of the RNS from the post-holder and service perspective. This includes examining the organizational infrastructure, working relationships, career paths, perceived benefits and enablers and barriers required to make this role successful. Methods: A naturalistic case study methodology was adopted and a variety of data collection approaches were used. These included semi-structured interviews with the post-holder, line manager and Director of Finance, non-participant observation of practice, review of job description, audit data and other relevant documentation relating to the post. Findings: Findings revealed evidence of the role being innovative and effective. These related to the role context; role delivery, skills and knowledge required; the personal characteristics of the post-holder, the impact on multidisciplinary integrated working and the response to the needs of patients and communities. Conclusions: This case study illustrates the value and potential of nurses to lead and co-ordinate the care for patients with chronic diseases, and specifically the provision of a high-quality respiratory service.