It is being increasingly recognised that the achievement of improved health outcomes for people with learning disabilities is central to the role of learning disability nurses. This is in recognition of the fact that an increasing body of evidence has demonstrated that these people often have poorer health outcomes than those in the mainstream population. Whilst accepting the role of the nurse in this regard, this paper argues that the continued enactment of that role solely within the margin, whether metaphorical or literal, will fail to achieve improved outcomes and will prolong the marginalisation of people with learning disabilities. In identifying the basis of such outcomes to be social inequity, it proposes that nursing must act in two orientations: health-oriented service provision and social activism. It is argued that only when such an approach is adopted will there be a real opportunity for people with learning disabilities to achieve optimal health outcomes. (Contains 3 figures and 1 footnote.)