Nursing is everywhere in healthcare and at all levels, and is among other things numerically dominant. Yet it arguably plays a less prominent role in charting the future course of the system than it should. As in any complex system, power matters in health, and the history of healthcare and gender relations explains a good deal of why nursing's influence has not rivaled that of medicine. But society has progressed immensely in the last century and nursing has both contributed to and benefited from these broader social trajectories. If the profession is to expand its leadership role in healthcare, it will have to reflect on its internal politics, its culture of representation and decision-making, and how to translate its diversity into a coherent change agenda. Perhaps above all it must champion and focus on the public interest to avoid being defined as just another interest group.