The changed conditions for nursing management of hospitals with diversified forms of organisation are discussed. These changed conditions influences and challenges the management and development of nursing, and nursing has to be seen as an integrated unity/synthesis with many other professions. In this context strategic and nursing management as a responsibility for all, i.e. for the individual, for the group, for the organisation in a hierarchial context, for networks, and for projects is also discussed. It is stressed that it is an important strategic challenge for the nurses to be able to create and communicate an increased focus on the patient in the quality of nursing and development of competencies.