This paper is a study of the clinical grading policy for nurses in the United Kingdom and the extent to which the participating groups in the policy development process realized then objectives The study is based on the literature available at the time of the research and the results of structured interviews with a range of individuals involved in the policy process The results expose the cleavages between the different representative groups on the staff side They also shed light on the differing power bases of the groups involved In particular, they expose the weakness of nursing as a professional pressure group and the strength of the state and its agents in determining the outcomes of policy in the public arena It is suggested that this weakness vis-à-vis the state is responsible for the failure of nurses to achieve a reward system which recognizes the value of clinical nursing expertise, and that the ‘clinical grading’ system, in practice, is having the opposite effect The policy is explored from its origins, its acceptance on to the political agenda, its negotiation and agreement, its contentious implementation, the final outcomes, and its failure to establish a valid‘clinical’pay structure