To deliver specialized care to those in mental institutions, mental nurses were required to possess specific qualities and demonstrate unique abilities, such as sympathy, intelligence, and trustworthiness (Church, 1982). Other essential attributes included knowing how to calm the nerves of an anxious or suicidal patient by using empathy and tact. Mental nurses' abilities set them apart from other nurses, but were difficult to define and understand, for they were ethereal in nature and not easily describable. (Silverstein, 2006, p. 33)

These understandings, described by Silverstein as "ethereal" have become a basic core set of values for the nurse in training and practice and must not be lost, regardless of the transition to autonomous scientific-based care.

Hales et al. has the most comprehensive description of the modern trend to create specialized autonomous care, focusing on scientific training and assimilation of autonomous specialty nurse practitioners in mental health care.

Major shifts in today's healthcare system have resulted in a clear demonstration that advanced practice nurses (APNs) are able to provide cost-effective, high-quality care to patients and their families (Cooper, 2001; Gabay & Wolfe, 1997; Mundinger et al., 1999; Pinkerton & Bush, 2000). Although much of the focus has been on nurse practitioners (NPs) in the primary care setting, APNs in specialty areas are receiving growing attention. Specifically, psychiatric-mental health APNs (both clinical nurse specialists and psychiatric nurse practitioners) have become significantly more visible in providing care to the mentally ill population (Baradell & Bordeaux, 2001; Puskar & Bernado, 2002; Society, 1997). and, just as primary care NPs have altered and positively affected the primary care environment (Pearson, 2002; Simpson et al., 2001), psychiatric-mental health APNs have become key players in building a mental healthcare environment and infrastructure that increases patients' access to quality care, while reducing overall costs. (Hales, Karshmer, Williams, Mann & Robbins, 2004, p. 93)

Though Hales et al. stresses the significant factors associated with autonomous care trends he also discusses the role of training nurses in science and core values (such as nurturing) at the highest levels of nurse training to maintain a continuum of care that pays particular attention to the strengths of the nursing industry, while still making sure to transition practitioners into autonomous...

While Raingruber emphasizes the strength of core values in the nurse patient relationship, Silverstein reiterates the potential for this relationship to be lost in the science and lastly Hales et al. The authors reiterate the need to fully train autonomous specialized nurse practitioners in the field, through the science and the core values of nursing care. Each of these works is in some way reflective of the necessity of finding balance between the traditional roles of nurses as nurturing and the need to fully explore the possibilities of the science of medicine as an aspect of a full preparedness for an autonomous role.
Conclusions I draw from the experience of a fuller understanding of the need to broaden the collective responsibility of nurse practitioners in a way that does not forsake the nurturing role of nurses, over the autonomous authority of primary care provider in specialty psychiatric care are congruent with the ideals of transition. As advance practice nurses and especially specialty nurse practitioners broaden the scope of their practice, through autonomy they and those who train them must reiterate core values of the nurturing nurse-patient relationship and there is no more clear example of this than in psychiatric care as the content and context of psychiatric illness requires all the core values of the nurturing relationship and a current need to understand the science of medicine, especially as it applies to pharmacology, an ever evolving field in psychiatric care. Balance is in fact the most crucial of all transitions as balance will determine the face of the future for autonomous primary care nurse practitioners.