This paper looks at five historical trends in the field of macro-policy making for nursing. From these it postulates that nursing is, now, a pluralist structure with three main interest groups. Each interest group has its own view of reality and therefore its own goals and strategies, some of which are in conflict with those of the other groups. Furthermore, the goals of the nursing groups are also in conflict with those of the government health department. The paper proposes a typology for nursing which takes account of these conflicts, helps to identify the areas of conflict and makes a proposal for the future structure which would help to achieve a more harmonious framework in the NHS.