District nurses constitute the basis of the primary health care services in Dominica. All encounters of three district nurses were registered using the international classification of primary care. Information on other aspects of district nursing was collected by participating observation and the use of a questionnaire. Check ups for hypertension, diabetes, pregnancy and immunisations constituted 40% of all reasons for encounter. The district nurses dealt with 80% of all contacts; only 20% of all patients were referred to the district medical officer. There are several discouragements to the motivation of the nurses. In addition to being a nurse, all have their family and other obligations. Postgraduate training with diversified certification and upgrading of wages could contribute to a continued high motivation and Increased job satisfaction. (C) 1998 Elsevier Science Ltd. All rights reserved.