Despite renewed efforts at reform in most European countries, the number of uninsured people continues to grow, the cost of healthcare continues to soar, and the safety and quality of care are queried. The great challenges of the healthcare system need significant attention on the part of health experts, policy makers and the society. One problem that has continued to dog the health care sector over the last five years has been the perennial shortage of registered nurses as well as other health care professionals as a demonstration of the fragility and faults in the health care system. For health care delivery to be efficient, reasonable, and inexpensive, there must be an ample stream of knowledgeable, well spread and employed certified nurses. While the general quality of care seems to have responded progressively to the rising emphasis on evidence-based practice and performing procedures, major inequalities in quality stubbornly persist. The health care system and the nursing profession are once more witnessing a shortage in nurses that is augmented by shortcomings of the system and the ever-rising need for health care, as the baby boomers grow old. The intricate environment of challenges of the health care system requires major attention on the part of health care professionals, policy makers and to a smaller extent the public.In all the health care literature available today, the widely accepted elements of health care reform are the ability to get health care, its quality, cost, and the workforce.