Currently, the community of academic nursing centers finds itself in an age of both uncertainty and opportunity. In this article Sara Barger, Dean and Professor at the University of Alabama, Capstone College of Nursing and RWJF Executive Nurse Fellow (2000-2003), discusses this progression through the past quarter century within the nursing education environment. The eras Barger identifies in her discussion are: (1) The Age of Traditional Health Insurance; (2) The Age of Regulated Prices for Government Programs; (3) The Age of Markets, Purchasing and Managed Care, and finally the present; and (4) Age of Uncertainty and Opportunity. The first of these eras saw the nascent development of the academic nursing center. In the subsequent period, a series of conferences sponsored by the Robert Wood Johnson Foundation established the academic nursing center as a vehicle for facilitating faculty practice. Meanwhile, increased reliance on federal funds for start up resources compelled the centers to become more businesslike in order to conform to government regulation and achieve self-sustenance. In the age of markets and managed care (1993–2000) the dynamic of nursing education was marked by plummeting enrollment into nursing schools. Competition for restricted resources rendered it necessary for the academic nursing centers to become business operations for the schools. The present age of uncertainty and opportunity sees academic nursing centers equipped with a new vision built primarily on patient-centered medicine, evidence-based practice, and quality improvement. Today, academic nursing centers face the twin challenges of balancing the service needs of their clients with the academic needs of their sponsoring programs and continuing to do more and better with fewer resources.