Abstract
The paper, a response to the Ministerial Taskforce on Nursing, has been developed to contribute to the current discussion about nursing practice.  The evolving conceptualisation of the scope of practice in New Zealand is scanned as the backdrop for critique of the current trend.  An overview of some aspects of developments in the United Kingdom and United States serves to highlight some significant issues concerning the potential for nurses to contribute innovatively to health care in the new era of change.  An alternative conceptualisation of practice in three nurse role categories is presented as the interrelationship of scope and expertise to illustrate how the trend to specialisation might be incorporated in a service scheme founded in the discipline of nursing.

Keywords
advanced nursing practice, clinical nurse specialist, nurse practitioner 

Introduction
The introduction of nurse prescribing and the ongoing delegation to nurses of other traditionally medical activities again raises the issue of how nursing practice is conceptualised, a variation of the old question; what is nursing? We must articulate nursing practice in the context of the new and still reforming health system.  The 1998 Ministerial Taskforce on Nursing (MTN) report acknowledges the significance of “advanced practice” to influence greater effectiveness and efficiency in health care.  This paper is developed in response to that report.  Through a critical overview of the New Zealand trend and with reference to developments in the United Kingdom and United States, I point to some important issues and concerns about the evolution of professional practice.