Registered Nurses (RNs) influence the health of individual patients and populations. RNs provide the most value for the healthcare system when they work collaboratively with other healthcare team members, work to their full scope of practice, and when they are engaged and accountable. In 2011, the Institute of Medicine report on the future of nursing made the call to achieve the full value of nursing care. Creation of this future state requires both a vision of the “to be” as well as removal of existing barriers. In this article, we present a description of this future state in the context of a team based culture that utilizes collaboration to achieve the full scope of practice, accountability to deliver healthcare based on a discrete body of knowledge, and accountability to provide value and measure effectiveness of nursing care. This proposed future vision focuses on patient advocacy for nurses working in healthcare systems. Barriers that currently exist, such as overlaps in professional scopes of practice, organizational policy and structure, and a lack of the ability to grant privileges to nurses based upon their education and skills are discussed. We offer recommendations to remove barriers and contribute to creation of a new future state of nursing, and conclude that the removal of barriers to inhibit the fullest scope of nursing practice will continue to require focus in purpose and persistence in action.