The article present the results of a project carried out by a group of four nurse managers of the Hospital "Ospedale di Circolo Fondazione Macchi" in Varese, Italy, in order to constitute the "Nursing Service". The Authors have described the initial situation with the traditional leading nursing roles in the Hospital (Nursing Officer and Director of the Nursing School) defining the objectives of the project. The goal of the Service has been identified, the organizational structure has been chosen and the different line and staff functions described. The conclusions inform on the current situation and work for the accreditation of the Service according to the mission of the Hospital managers and the announced changes in Lombardy health policy.