This pilot study in a specialist mental health crisis assessment and treatment setting compared patients’ outcomes and level of satisfaction in nurse-initiated care and in treatment as usual. There were no significant differences between nurse-initiated care and treatment as usual in terms of HoNOS scores or consumer and caregiver satisfaction. This was not due to clinical or demographic differences between the two groups nor to an inadequate sample size. Overall, the nurse was found to follow best or acceptable clinical practices. The findings indicate that the nurse practitioner role can potentially initiate safe and effective mental health care and treatment that is as satisfying as that initiated by a physician. Additional, larger-scale research is required to determine the generalizability of these findings.