The times they are a changin.

AIM: A discussion paper outlining the potential for a multi-qualified health practitioner who has undertaken a programme of study incorporating the strengths of the specialist nurse with other professional routes.

BACKGROUND AND RATIONALE: The concept and the context of 'nursing' is wide and generalized across the healthcare spectrum with a huge number of practitioners in separate branches, specialities and sub-specialities. As a profession, nursing consists of different groups in alliance with each other. How different is the work of the mental health forensic expert from an acute interventionalist, or a nurse therapist, from a clinical expert in neurological deterioration? The alliance holds because of the way nurses are educated and culturalized into the profession, and the influence of the statutory bodies and the context of a historical nationalized health system. This paper discusses the potential for a new type of healthcare professional, one which pushes the intra- and inter-professional agenda towards multi-qualified staff who would be able to work across current care boundaries and be more flexible regarding future care delivery. In September 2003, the Nursing and Midwifery Council stated that there were 'more than 656 000 practitioners' on its register and proposed that from April 2004, there were new entry descriptors. Identifying such large numbers of practitioners across a wide range of specialities brings several areas of the profession into question. Above all else, it highlights how nursing has fought and gained recognition for specialisms and that through this, it may be argued client groups receive the best possible 'fit' for their needs, wants and demands. However, it also highlights deficits in certain disciplines of care, for example, in mental health and learning disabilities. We argue that a practitioner holding different professional qualifications would be in a position to provide a more holistic service to the client. Is there then a gap for a 'new breed' of practitioner; 'a hybrid' that can achieve a balanced care provision to reduce the stress of multiple visits and multiple explanations?

METHODS: Review of the literature but essentially informed by the authors personal vision relating to the future of health practitioner education.

IMPLICATIONS FOR NURSING MANAGEMENT: This article is of significance for nurse managers as the future workforce and skill mix of both acute and community settings will be strongly influenced by the initial preregistration nurse education.