The objective of this study was to create a model of nursing practice in Sub-Saharan Africa based on population needs, current practice and expectations of stakeholders. A three component study was done in eight sub-Saharan countries to ascertain (1) the health needs and the burden of disease in these countries, as well as evaluating the structure of their health systems; (2) the views on nursing functions held by opinion leaders in the community, other health professionals, patients and their families; and (3) to conduct a survey of nurses and midwives to determine the roles that they actually perform in hospitals and public health centres (PHCs). Four Anglophone and 4 Francophone countries were studied with a document audit, and 191 stakeholders included in focus groups. The current practice of 734 nurses in ambulatory and hospital settings was evaluated. Based on a triangulation of this data, 9 roles were identified: the provision of holistic care, health education, managing the care environment, as well as the advocacy and collaboration, providing emergency care, providing midwifery care, prevention and management of infectious diseases and diagnosis and treatment. Three contextual support factors (positive policies and practices, an enacted regulatory framework and an enabling educational system) were also identified.