BACKGROUND: People with non-ST-segment acute coronary syndrome (NSTACS) need to receive appropriate evidence-based therapies to optimise outcomes. Nurses could play an integral part in ensuring appropriate care. AIMS: An integrative literature review was prepared to evaluate the role nurses undertake during the acute phase in identifying, risk stratifying and managing patients with NSTACS. It also aimed to assess what role they might play in guideline adherence for this patient group. METHODS: Papers published between January 1990 and November 2011 were considered for inclusion. They were identified through four electronic databases. Articles were evaluated and data extracted by two reviewers. RESULTS: From 38 papers read in full, 10 were eligible for inclusion. One reported on a randomised controlled trial, four on qualitative projects and the rest on postal questionnaires or case-note data. Reviewed literature suggested that nurses in the acute setting perform five different roles in the care of people with NSTACS: educator, comforter, risk rater, data conduit and decision maker. Little research was found that addressed nurses' role in guideline adherence. CONCLUSION: Just as nurse-led or nurse-initiated thrombolysis improved care for ST-segment elevation, there is the potential for nurses to improve acute, evidence-based treatment for patients with NSTACS, especially those at higher risk. Nurses' roles in acute coronary syndrome (ACS) should include objective global risk assessment to guide early treatment decisions and incorporate the varied and rich activities identified in studies presented in the review.