Purpose--The purpose of this paper is to investigate the dramatic reforms in the health service in recent years. Design/methodology/approach--Examines management development in health care, and explores the experiences of clinical nurse managers. Findings--Duplication of agencies and multiplication of roles have led to tensions in terms of both the management and organisation of the health service and pressures to accommodate local and national agendas have proved difficult and, as such, a complex, bureaucratic organisation is seen to be the resultant outcome. Originality/value--This paper fulfils the need of exploring the experiences of clinical nurse managers in the NHS. (Contains 2 figures and 1 table.)