Introduction

Practicing as a nurse within the present health care system is a challenge. There are many constraints and obstacles making it difficult to provide consistent high quality care to individuals. Dunleavy et al (2003) state, �As a result of having to do much more with much less, nurses are experiencing increased fatigue and burnout� (p24).

Health care professionals are faced with the task of how to meet the needs of the patients with limited resources. Traditionally, administrative personnel determined who and how those needs were met without significant input from individuals responsible for administering the care to patients. The development of new roles for nurses should be a collaborative process involving reflection on the past, present and future practice of the nurse in a guided process facilitated by a leadership role. Identifying who needs a nurse and what those needs are for patients should be the first step towards implementing new care models.

The technical and practical roles are often clearly identified and valued within organizations. The desire to promote "Reflective Practice" is especially important during a period dominated by what Benner (1984) refers to as "twin dragons of turnover and technology" (cited in richardson, p 1044). The importance of the emancipatory role in supporting patients throughout the trajectory of their illness experience should also be a consideration. The latter is considered a significant aspect of todays nursing educational programs. Despite this many, nurses feel there is not enough time to provide this support to every patient.

Through the process of reflection on practice nurses can identify the needs of the patients they care for and work collaboratively with other healthcare members to improve patient outcomes. This is one of the biggest challenges for us all during healthcare reform.