This article describes the perceptions of a visiting lecturer exchange experience between Wolverhampton University, School of Nursing and Midwifery, and the University of Kentucky, Lexington, in the American state of Kentucky. The major goal of the visit was to learn health assessment skills to bring back to future advanced practice programmes within the university. The opportunity to work with a variety of nurse practitioners culminated in a unique review of the training development and evolution of advanced nursing practice in Kentucky. Some of the conceptual confusions of advanced nursing practice are explored, together with the features of a new blended role which combines the practice of two traditional positions: the medical skills of nurse practitioners and the expertise of clinical nurse specialists.