This paper discusses the diversity of portfolio use highlighted in a study funded by the English National Board for Nursing, Midwifery and Health Visiting exploring the effectiveness of portfolios in assessing learning and competence (Endacott et al., 2002). Data collection was undertaken in two stages: Through a national telephone survey of Higher Education Institutions (HEIs) delivering nursing programmes (stage 1); and through four in-depth case studies of portfolios use (stage 2). Data collection for stage two was undertaken through field work in four HEIs purporting to use portfolios as an assessment strategy, and their associated clinical placement settings. Four approaches to the structure and use of portfolios were evident from the stage 2 case study data; these were characterised as: the shopping trolley; toast rack; spinal column and cake mix. The case study data also highlighted the evolutionary nature of portfolio development and a range of additional factors influencing the effectiveness of their use, including language of assessment, degree of guidance and expectations of clinical and academic staff.