Before autonomy in nursing practice can become a reality, nurses must clearly identify their roles. This role identification is no easy task given the impact of significant changes taking place in acute care hospitals and the various levels of nursing practice found in most institutions. The authors advocate using middle managers and a committee of nurses with various interests and educational preparations to study the issues and reach a consensus as to the role of nursing. As the work of different hospital groups is shared with others, autonomous nursing practice will be a step closer to reality.