As we start out on our path into the millennium, there are a number of key issue we need to consider about our future in nursing. Whilst many readers may groan at such a statement it is worth remembering the difference between nursing at the beginning of the last century and today. Clearly nothing is static, change is inevitable and, if we want to be proactive in leading change, we need to consider the options open to us now so that we drive the agenda for nursing in this century rather than letting others do as has sometimes been the case in the past.