When our ancestors first came to America they landed in what was for them uncharted territory. Our family histories are filled with stories of bravery and courage, risk and reward, along with failed experiments and grave mistakes. Today, nurses who have moved beyond the walls of traditional institution-based nursing are also moving into uncharted territory. The changes in patient population, length of stay at healthcare facilities, resources for clinical practice and our cohort of peers and co-workers are calling this generation of nurses to create new ways of practicing their professional roles. Studies show that 52 percent of nurses are practicing in traditional healthcare settings, and by the year 2010, that number will drop to less than 40 percent. In particular, nurses in the outpatient world are crafting a new model for professional practice.

The timing could not be better: A nursing shortage of unparalleled magnitude is sweeping this country and the globe. Unfortunately, many young people presently selecting careers buy into the prevalent image of nurses as subservient practitioners carrying out medical orders. They do not realize that nursing today provides the kind of autonomous and innovative professional opportunities that they seek.

The patient population moving through outpatient settings demands a new kind of care management, and is especially challenging for three reasons: First, as ambulatory patients often have multiple co-morbidities, their nurses must be prepared for the worst, even when procedures themselves are relatively minor. Second, because exposure to these patients is brief, nurses must effectively educate them to manage their health issues at home. Third, the patient population is diverse; therefore nurses must be able to switch gears when caring for and educating patients-from the healthy 45-year-old executive who comes in for a bunion removal to the 80-year-old retiree who needs a hip replacement. So traditional diagnosis-focused solutions are giving way to patient-focused interventions that begin with a partnership between nurse and patient. Nurses working in the outpatient environment need to be especially responsive and resourceful to meet these many challenges. Of course, we nurses enjoy good challenges and the opportunities they offer.

As we make our work known to the public through recruitment efforts and the media, and as the public experiences our work, the image of nursing will shift as dramatically as it did in the 1960s, when technology fostered the emergence of high-tech healthcare, which in turn gave birth to critical-care nursing. The richness of new nursing roles will be a magnet for men and women seeking a career that is both rigorous and rewarding. And they will see, through their encounters with nurses, that standing with someone in a moment of crisis or need is among the greatest privileges that life has to offer. By becoming all that they can be, nurses will address the nursing shortage in ways that all the advertisements in the world cannot.

Whether you're an administrator or new charge nurse, study our pioneering nurse colleagues, identifying the qualities they have demonstrated: courage, willingness to take risks, integrity, intellectual hunger, and passion for their work. Incorporate all of these things into your own work and nursing will evolve into the kind of relevant, powerful healing force it is meant to be in the 21st century.