It starts in Duke Point, at the ferry terminal there. It immediately heads south as the Duke Point Highway to Cedar, and then heads west to Highway 1, where it merges onto it from the east. The two highways then share a common allignment tnorth just a little ways before Highway 19 diverges west. From the Highway 1 junction, Highway 19 is known as Nanaimo Parkway, and bypasses Nanaimo. Just after passing through Wellington, it officially recieves the Island Highway designation.