Weaning patients from mechanical ventilation and extubating them following cardiothoracic surgery has traditionally been the responsibility of medical staff. Within critical care settings some nurses, with the appropriate experience, actively take part in this process under the direction of an anaesthetist. In the Adult Intensive Care Unit (AICU) of Royal Brompton Hospital, a policy was developed to enable nurses to wean and extubate postoperative patients without the need for consultation with anaesthetic staff. It was envisaged that following the implementation of the policy other areas for nursing development and research would be highlighted. Issues relating to accountability, quality and practice are discussed.