Demographic trends, population projections and emerging health problems have a direct impact on health systems. These changes happen immersed in a socioeconomic environment and a constant concern for sustainability and solvency of the health and social systems. In this context, health promotion, preventive interventions and care for people with or at risk of chronic health problems gain relevance in public health policies. This suggests that nurses will have to assume an increasingly important role in the formulation of public policies, with particular emphasis on regulation, financing, provision and professional development. Governments must be aware of the contribution of nurses. Also, nurses have no choice but to position themselves. They have the ethical obligation to be involved in the highest level of decision making in order to improve population’s health, reduce health inequalities and participate in the governance of the system. Decision making and active participation in the design, formulation, implementation and evaluation of public policies necessarily implies understanding the context in which these decisions are taken, identifying stakeholders, their functions and the instruments they hold for the transformation of the health system. In order to integrate their current role in public policies, nurses must: 1) consider changes in health and social care policies based on the model, the system and the available evidence; 2) know demand, provision and public policies; 3) master regulation, evaluation and payment systems; 4) propose sustainable and efficient interventions, being aware of the opportunity cost; and, 5) enhance the contribution of nursing research through innovative solutions.