Rarely have the voices of nursing-and nurse leaders-sounded so clearly.

On October 5, 2010, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) issued the landmark report that's making waves in the health care community.

Marilyn P. Chow of Kaiser Permanente talked about expanding the potential of nursing practice-and easing the fears of those who might feel threatened.

"Be clear about independent practice and collaboration," she said. "Be explicit in the message to physician partners: it's not about replacing them but working with them to the full scope of practice." She added that we need to expand Centers for Medicare and Medicaid Services programs to cover advanced practice RNs in performing admission assessments and certifying the need for home care.

Catherine Alicia Georges of Lehman College of the City University of New York discussed increasing educational capacity to meet consumer needs.

"In pushing toward 80% of nurses having a baccalaureate by 2020," she said, "we need a national system, to standardize the curriculum, and sustainable levels of funding."

Jennie Chin Hansen of the American Geriatrics Society had a simple message about expanding leadership opportunities for nurses:

"We need to define and own our voice," she said. "It must be clear and unified."

Susan Hassmiller of the RWJF discussed the next steps in moving the work forward. (See her guest editorial in the December 2010 issue.) The RWJF will work with AARP to lead a coalition of diverse partners toward implementing the recommendations.

Regional action coalitions (RACs) in five states-New Jersey, New York, Michigan, Mississippi, and California-will explore ways to partner with key groups at the local, state, and national levels in promoting the recommended changes. The RACs will identify the best methods and assist other states in implementing them.

William D. Novelli, a member of the IOM committee, former president of AARP, and cofounder of Porter Novelli, an international public relations firm specializing in promoting health and social issues, said the key to making the IOM recommendations a reality is to establish the benefits of the change to each audience-for example, extolling the business case when talking with companies and highlighting the personal, emotional aspects when talking to consumers. "We must tell this story over and over," he said.

Hassmiller's final charge to the group was to commit to action, and she invited participants to say out loud what they were willing to do to move this work ahead. So many people stood in lines at the microphone, testifying to what they and their organizations would do, that the meeting ran late. Many were left standing at the microphones.

Novelli noted that, despite the overwhelming sense of commitment in the room, the proof will be in the pudding; the leaders must in turn generate a groundswell of excitement and support among their constituents.

In her summary, Beverly Malone of the National League for Nursing said, "We need to develop and communicate a clear and consistent message, aiming not [to be] mini-doctors but maxi-nurses."