This study was a qualitative study focused on participatory process management of nurses’ opinion expression on problems of the health care system, the vision of the Thai health system, the role of nurses, and awareness-building in health system reform participation. The principal informants were 1,269 nurses working at secondary and tertiary hospitals in the Northern region. Additional information and comments were provided by health care recipients, health care providers, and experts and nurses throughout the country, through brainstorming meetings (11), in-depth interviews (29), focus group discussions (11), round table discussions (2), a national seminar (1) and a national conference(1). Activities for group work, interview guidelines, focus group discussion guidelines, and questions for discussion in all meetings, were designed by the researchers, as were content analysis and category arrangement. Results of the study were as follows: 1. The situation of the health care system is reflected in the problems of service and care-providers, and the recipients. The service was seen as ineffective, under standard, and of low quality. Care providers were hampered by high workloads, insufficient skills, stress, few opportunities for development, and insufficient participation in organizational administration. Health care recipients complained of not receiving the benefits they were entitled to, the inequities and high costs of services, poor services, and the inadequate performances of the providers’ performance. They wanted to see a good system of service and appropriate fees, as well as care providers in adequate numbers with good knowledge and offering good relationships and kindness. 2. The vision of the Thai health system as proposed by nurses was envisaged as an active health service with equity for all. They also wanted to see health service personnel displaying good quality, morality, and proper conduct. They proposed that people and communities should participate in health care, and also that government and health organizations have policies and strategies promoting good health for the people. 3. The nurses’ vision for nurses’ roles in the new health system was discussed. Nurses at all levels should provide more active service; understand human nature, behavior, culture, beliefs and local knowledge; provide family and community care, as well as nursing interventions and rehabilitative services for sick persons; conduct physical examinations, make diagnoses and provide primary medical care; protect recipients’ rights and advocate for them; provide health information and knowledge; produce academic work, innovation and research; be leaders or team-mates in health teams; administer and manage the services and units; express ideas for the health system and professional development; and perform advanced nursing practices. 4. Key issues in health system reform were identified. They consisted of the equity and quality of care service, the effective health service management and decentralization, health building by self health care, adequacy of quality and number of health manpower, health knowledge building process and research, health coverage for good health, government and people participation in health policy making, and effectiveness of other health care systems. 5. It was agreed that nurses should participate in health system reform at the personal and professional organization levels. At the personal level, nurses should have awareness and understanding of new health concepts and educate others, be knowledgeable and competent in nursing actions, be responsible for continuous self development, and have a good attitude towards their profession, and participate in professional organizational activities. At the organizational level, the organization must participate actively in health system reform and related regulation formation; identify policies and directions for nursing education and service development; lead, coordinate and build understanding towards reform among members; and draw opinions on capacity building for leaders, quality control for the performance of newly graduated nurses and nurses in the workplace, and the establishment of quality assurance systems for the nursing service.