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Nurse executive leadership in academic health centers is essential to the improvement of nursing education, practice, and research. The author raises questions to highlight the dilemmas in which nursing finds itself at this time of dramatic transformation of health systems. The framework of the "learning organization" is used to examine the way in which leaders are defined in nursing and the way in which they perceive their roles. Comparisons are drawn between educational and practice administrators, and similarities and differences between these two groups are discussed. Integrative faculty practice roles are summarized, and innovations in advanced nursing practice are described briefly. Specific aspects of the research enterprise discussed are collaboration among members of the nursing discipline and examination and evaluation of quality-of-care issues. For improvement to occur, the author advocates involved, participatory problem solving by nurse colleagues in education and practice.