A result of recent National Health Service reforms is the need to investigate, and possibly change, the culture of the professional working relationship between members of staff and their employer. This is particularly the case in situations of mergers and acquisitions where staff working from different cultural environments must work together. Mergers are becoming a feature of health service provision, perhaps this becomes most obvious with the recent moves by colleges of nursing and midwifery into the higher education sector and amalgamations of some purchasing authorities. Mergers highlight the practical issues of bringing together different organizational and work cultures to deliver a high quality service. This article discusses some aspects of the nature of organizational culture, the human impact of mergers and acquisitions and offers strategies for managing these events.