Librarians in Sweden are facing huge challenges in meeting the demands of their organisations and users. This article looks at four key areas: coping with open science/open access initiatives; increasing demands from researchers for support doing systematic reviews; understanding user experiences in Swedish health science libraries; and the consequences of expanding roles for recruitment and continuing professional development. With regard to changing roles, there is an increasing shift from the generalist towards the expert role. The authors raise the issue as to how to prepare those new to the profession to the changing environment of health science libraries.