Nursing scholars from around the world have written extensively in the past decade of the need to transform current health care systems and of the role of nursing education in achieving this goal. Proposals for change abound in the literature and are beginning to emerge in practice but not without difficulties. Having examined new curricular developments, this paper will discuss barriers to further progress. It is suggested that emphasis on reforming schools of nursing and teaching practices has tended to overlook broader institutional influences, in particular the clinical settings in which 50% of nurse education occurs. This paper will outline the major themes of the curriculum revolution, examine the ways in which educational institutions, health care settings and nursing organizations hinder the progress of curricular reform, and discuss possible solutions and their limitations.