The past two years have demonstrated that we are not in a "new normal" but in something "new altogether." As a result, incremental change will not be enough to support the nursing workforce now or in years to come. This commentary summarizes a series of cross-generational conversations about the structural change needed to enable nurses to learn, work and lead in the health system of the future. We examine a series of questions (What ifs?) intended to challenge what transformational structural change could look like and call on the Canadian nursing community to collectively lead reform within the profession.