Nursing faces serious challenges as Americans' health care needs increase. Thoughtful and comprehensive planning for the future is essential to respond to these needs. The Nursing Practice and Education Consortium (N-PEC) met in Indianapolis in December of 2000 to complete "Vision 2020 for Nursing: A Strategic Work Plan to Transform U.S. Nursing Practice and Education." N-PEC is comprised of 10 organizations that work towards the common goal of assuring that the profession of nursing fulfills its responsibility to improve health, provide care and attract the supply of new entrants necessary to meet the needs of society. During the December 2000 meeting, the consortium created a framework for new health care roles. In this framework, four levels of clinicians would adhere to separate scopes of practice. Future work will specify these scopes and the corresponding skills, develop licensure procedures for each level, and design practice settings where the new scopes of practice and roles can be enacted with organizational support. This article provides a preliminary description of the four levels. Scope A includes home health aides, unlicensed assistive personnel and community workers; Scope B includes formally educated clinicians who use evidence in practice and are skilled at monitoring, assessing, implementing and delegating nursing therapies; Scope C includes licensed clinicians who are prepared to serve as independent practitioners; and Scope D includes clinicians who have graduate level education and Scope C licensure, perform sophisticated advanced practice roles or focus on scholarship and research, and are considered leaders in the field of nursing and health care knowledge. The next step for the consortium is to gain constructive feedback about their proposed framework, move through the revision process, and present a final version to the public.