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Background There is a long history of nursing practice in the area of electroconvulsive therapy (ECT). Opinions on the involvement of nurses in this treatment reflect the wider debate on its use in the professional and popular media. There is extensive literature on the issues raised by this particular treatment but little research into what nurses actually do when working with patients receiving ECT. Objectives The research question was: How do mental health nurses work with patients having electroconvulsive therapy? Design This was a Grounded Theory adopting a ‘hybrid' approach to the methodology influenced by the differing perspectives of both co-originators, Glaser and Strauss. Settings The research took place in wards and ECT departments in two hospitals in Scotland. Participants Twenty-four mental health nurses, including 4 students working in National Health Service hospitals in Scotland were accessed through purposive, then theoretical sampling. This included non-participant observation of nurses in their work with patients throughout the treatment period and unstructured interviews. Methods Analysis was based upon the constant comparative approach with open coding of data that was examined and compared for similarities and differences. This determined further data collection and theoretical development with regard to their properties and relationships to other codes until the point of saturation. Results Nurses' actions in ECT characteristically involve two role groups: relational roles and treatment roles and two dilemmas: uncertain role and uncertain relationships. The core category 'being there' comprising 'engaged', 'present' and ‘detached' accounts for nurses' actions in the ECT drama, approaches to difficulties encountered, and, paradoxically, how such actions contributes to this. Slipping is postulated as the basic social psychological process enabling nurses to manage their contact with the patient.