This article discusses the education and training needs of nursing staff undertaking the pre-assessment of surgical patients in the context of role development within health care. The authors undertook this piece of work as part of a project to inform the development of a competency framework for use by registered nurses working in the field of pre-assessment screening and preparation of surgical patients. A selective review of the literature on the education and training needs of pre-assessment nurses, and nurses undertaking expanded roles has been undertaken and some of the emerging issues are debated. The nature of current preparation for these roles and the apparent lack of any consistent approach to education and training for staff adjusting their scope of professional practice is debated. A brief review of the nature of competence and some of the different models including occupational competence models are presented. Finally, the implications of these for the development of a strategy for the acquisition and demonstration of knowledge and skills in pre-assessment nursing staff are presented.