This paper was presented in the context of an international interdisciplinary conference on Priorities in Health Care. The focus of the paper is the relationship between the nurse's role and the demands of patients, now and in the future. The incongruence between patients' needs and their demands is discussed and the question is raised as to whether the nurse's skills and knowledge currently acquired will be appropriate to meet patients' needs and demands in the future.

Future patient needs and demands are not the only external pressures on changes in the nurse's role; advances in medical treatment and technology and changing roles of other health professionals are others. The paper highlights the dilemma between the profession having to give way to such external pressures or the risk of preparing nurses for irrelevant roles. A case is made for greater interchangeability of first level health care workers through a common portal of entry. It is suggested that diversion into the various professional fields should occur after the foundation course to health care and suitable counselling.

Among the top level professionally qualified nurses should be both generalists and specialists. A speciality of nursing generalism, as a parallel with general medical practice, is advocated. A plea is made for a liberating rather than a restricting interpretation of professionalism so that necessary changes in the nurse's role can be initiated and directed by the profession rather than being forced upon it by external pressures.