Quietly, in 1997, the country of Turkmenistan embarked upon an initiative destined to transform the image, practice and impact of nursing while changing the environment towards primary health care for its population. Support for this initiative came from USAID funding, beginning in 1999, through a partnership between the Ministry of Health of Turkmenistan and the State of North Dakota. Now, five years later, several accomplishments are noteworthy: (1) Over three hundred nurses have completed an intensive primary health training curriculum sponsored by the Ministry of Health at the National Family Medicine Training Program which was established with the partnership, (2) Nurse graduates, working hand-in-hand with physicians and the community, are introducing a new environment of health promotion, health education, and health outreach in the clinics and homes throughout the capital city of Ashgabat, (3) Nurses graduates are integral partners and leaders in the Family Medicine Practice Center established two years ago as an experimental unit in primary care, (4) Nurses graduates transferred their new skill set to a Family Medicine Training Program on the Turkmenistan/Uzbekistan Border. Within five years a nucleus of reform minded nurses has emerged that will continue to influence the direction and environment of health care in Turkmenistan as it continues moving towards a primary care model of health delivery.