Highway 19's northern end is located at the Bear Cove ferry terminal, across the bay from Port Hardy.

The highway then follows the eastern shore of Nimpkish Lake and the Nimpkish River through a long stretch of dense forest terrain for 64 km (40 mi) southeast, until reaching a junction with the community of Woss, then travelling another 65 km east (40 mi), through the boundary between the Regional Districts of Mount Waddington and Strathcona, to a junction with Sayward, and finally entering the city of Campbell River another 64 km (40 mi) southeast, at a junction with Highways 28 and 19A, just past the river that the city is named for.

South from Campbell River, Highway 19 is divided primarily by a concrete wall, and goes through a series of six spaced out at-grade signalized intersections, five of them possessing exit numbers.

16 km (9.9 mi) later, Highway 19 reaches another interchange, this time with a two-lane road that goes a short distance east to the B.C.

It heads mostly southeast through the communities of Nanoose Bay and Lantzville passing 5 signal lights and many at grade intersections along the way before finally entering the north part of Nanaimo.

In Nanoose Bay the presence of a particularly busy signal light, multiple residential properties on the highway, a dense cluster of several intersecting side roads, and the lack of a centre divider results in a 60 km/h (37 mph) speed limit.

Highway 19 then veers south onto a 20 km (12 mi) long four-lane expressway known as the "Nanaimo Parkway" which opened in 1997.

[1] However by 2021 the parkway itself was beginning to have serious congestion issues at the signal lights as a result of the highway being flooded with commuter traffic from a growing Nanaimo.

With further growth in traffic expected over the next 30 years the Ministry of Transportation has begun to study the implementation of interchanges on the parkway in the near future.

Opened in 1997 the 7.5 km (4.7 mi) long Duke Point Highway begins as a 4 lane undivided freeway.

There is heavy traffic on the highway for short intervals when ferries are unloading but the rest of the time the Nanaimo bound lanes are virtually empty.

[3] A sod turning ceremony had been held three years earlier in April 1962 and was officiated by Phil Gaglardi, the Highways Minister.

Due to the rapid growth of Nanaimo the southern sections of Highway 19 are expected to handle an increasing amount of traffic.

To address these issues the BC Ministry of Transportation initiated the Nanaimo Parkway and Nanoose Bay Corridor Study.