Staff in an NHS trust and a university faculty worked collaboratively to develop a specific course for nurses working in high dependency areas. Initial evaluation suggested that there has been a positive impact on practice in that nurses who had completed the course were willing to share new knowledge and undertake teaching; management of patient care had become more effective; and the nurses were more willing to care for sicker patients. Nurses had also developed critical and reflective skills and were keen to review and develop practices through activities such as audit. This project has highlighted not only the need for practice based experience in caring for the critically/acutely ill patient but also the need for formal educational input from expert staff. It is concluded that advances in practice must be supported by appropriate education and training, and organisations need to work collaboratively in order to respond to the needs of staff and patients.