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Nurses do not have proprietary rights on caring: but we do on clinical practice models.

Across the world, a perfect storm is intensifying for nursing creating many challenges but also exceptional opportunities. The increasing numbers of individuals with chronic and complex conditions and fiscal constraints are challenges to human resources for health and the increasing demand for universal health care coverage. These factors defy existing models and paradigms of caregiving requiring innovative solutions. (Ooms et al. 2014). Paradoxically never before have nurses been so welleducated and their skill set aligned with the demands for evidence-based, person-centered care. We as a profession are ready to rise to these challenges and it is our time (Davidson et al. 2013, Daly et al. 2014). In decades gone by, nurses and their role were much more homogenous and foreseeable. The majority of nurses were educated in hospital settings and their role was much more predictable and controllable. Health care was primarily provided in hospital settings and physicians largely determined nurses’ scope of practice. However, times have changed, nurses are now not just highly skilled but educated and do their work in a range of settings – from the bedside to the boardroom (Shaffer et al. 2014). Moreover, they continue to develop and evolve innovative ways of delivering care and improving patient outcomes. The role of patients in health care is also changing. Increasingly patients and their families are engaged in caregiving and delivery as partners, not merely the recipients of care (McMullen et al. 2014). Importantly, the importance of informal caregiving and family caregiving are becoming critical in caring for the many individuals requiring ongoing care in the community (Shah et al. 2014). In the United States alone, it is estimated that informal caregivers contribute care estimated to be at a value of $522 billion and replacing this with skilled nursing care would cost $642 billion a year (Chari et al. 2015). This altered milieu requires a new suite of skills: counselling rather than didactic education; shared decision making rather than prescriptive planning; and tailoring and targeting care delivery models rather than expecting patients to comply and adhere to our traditional ways of working (Barry & Edgman-Levitan 2012). In response to these challenges, there have been calls to increase the numbers of baccalaureate-prepared nurses prepared to undertake and coordinate increasingly complex care models. However, both the supply and demand of these nurses, as well as costs, have challenged an all baccalaureate-prepared nurse workforce. Increasingly, there is heterogeneity in workforce delivery models and varying levels of nurses are employed as well as technical assistance and nursing aides (Auerbach et al. 2015). We also have additional levels of health care workers, such as physician’s assistants (Dill et al. 2013). The trend towards diversification and heterogeneity in the workforce is a global phenomenon (Kerry & Mullan 2014). Moreover, in the community we are increasingly dependent on community health care workers who play a critical role in brokering care, community engagement and care delivery (Islam et al. 2015). Increasing diversification of the nursing workforce has increased discussion and debate on the protected role of ‘nursing’ as well turf issues in care delivery. Similarly to how nurses have embraced tasks and skills previously attributed to physicians, we also need to loosen the reins on our hold on the proprietary rights of caregiving. We have to be open and responsive to sharing the field with a diverse and heterogeneous cadre of health care workers, as well as family members. Many of these individuals have the knowledge, skills and capabilities to care for the increasing numbers of individuals requiring health care. We need to embrace our new co-workers. As the health care environment rapidly changes and the fabric of the health care workforce becomes more diverse we need to accommodate changes, be prepared to negotiate and strive for health care that is equitable and accessible. In this new environment, we cannot and should not release our important leadership role in the clinical practice environment. The community looks to us for