In this summary report proceedings from the 2002 National Invitational Conference for Executive Nurse Leaders are presented. The conference addressed the challenges and opportunities that face executive nurses in the current health care environment. The report was divided into three sections: 1) addressing health care quality; 2) understanding the work environment and how it affects nurses and the care they provide; and 3) detailing opportunities and related strategies to improve the health care environment. Conference participants underscored the role that nursing executives could play in improving the health care environment as they partner with patients (and their families), as well as collaborate with one another. The structure of health care organizations, nursing and other health care provider shortages, and the interaction between these factors were related to lower job satisfaction, burnout and reports of reduced quality of care. Some of the recommended areas for nursing executives to focus on in changing the health care environment were: being responsive to the needs of patients; promoting caring relationships with patients; collaborating with non-health care organizations; using technology and data from research more frequently and effectively; and becoming involved at the policy level. Case reports were included at the close of the report to illustrate some of the recommendations put into practice by executive nurses.