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Objectives To identify challenges in stroke care services and stakeholders’ expectations for the role of stroke advanced practice nurses (APNs) in the neurology department of a tertiary hospital in ainland China.Design A field study using participatory observation and in-depth interviews.Setting The neurology department of a tertiary hospital in Sichuan Province, China.Participants The principal researcher conducted participant observation in the capacity of a clinical nurse. In-depth individual interviews were conducted within 7 stroke patients and their carers, 4 doctors and 10 nurses.Results Key challenges included a shortage of specialised professionals, imprecise, untimely and discontinuous care, poor medical–nursing collaboration, limited nursing expertise and unmet patient needs. Stakeholders expected stroke APNs to fulfil six roles: stroke care expert, advanced clinical practitioner, collaborative coordinator, specialist care innovator, specialised educator and role model.Conclusions Stroke APNs should provide precise, timely and continuous care for patients while enhancing team cohesion, overall competence and service quality.