Nursing history is rich with individuals who have overcome barriers to impact their environment. Florence Nightingale not only introduced nursing as a science; she was also one of the first public policy advocates. She looked at an unhealthy environment, and used her political skills to effect change. Nursing organizations are mirroring this patient advocacy role in many forums. This article discusses the varying attitudes toward the role of nurses in public policy, from indifference to action. Suggestions for changes in the educational process are reviewed. Finally, public policy strategies for critical care nurses to use in tobacco control and end-of-life care are discussed.