In addition to his medical work, Nelson served frequently as a leader in the LDS Church. In Minnesota, he served as what was then known as Sunday School superintendent in his local congregation. In Washington, D.C., he was a counselor in the
bishopric of the ward that church apostle
Ezra Taft Benson regularly attended while serving as secretary of agriculture to
Dwight D. Eisenhower. In Massachusetts, Nelson was the secretary for the adult
Aaronic priesthood organization in his Boston-area branch. After returning to Salt Lake City, he was called as priest quorum advisor in the Garden Park Ward, working with over fifty boys ages sixteen to eighteen. He next served as member of the Bonneville Stake YMMIA superintendency (a position that is roughly equivalent to a modern counselor in the stake young men's presidency) and then as a counselor in the bishopric of the Garden Park Ward. He was
set apart as a counselor in the bishopric by
Joseph Fielding Smith, whose son-in-law was the bishop. Nelson served in that bishopric for over five years at a time when the ward had over 1,000 members. He then moved to the Yale Second Ward, still in the Bonneville Stake, and was called as a member of the
stake high council. He later served as a
stake president in Salt Lake City from 1964 to 1971, with fellow future apostle
Joseph B. Wirthlin serving as his second counselor. From 1955 to 1965, Nelson served as a missionary on
Temple Square every Thursday afternoon for about two hours giving tours to visitors. This
calling was extended by
Richard L. Evans, an apostle and the lead figure over publicity efforts on Temple Square. Nelson also served for eight years as the church's Sunday School general president. During his tenure, the Sunday School developed a unified eight-year cycle of covering the church's scriptures in its curriculum. There was also a shift from having members of the Sunday School general board do all the training for new teachers to providing materials which developed into the book
Teaching: No Greater Call. Early in his service as an apostle, Nelson was an adviser to the church's
Young Women organization and was supportive of the developing of the Young Women values and
Personal Progress program. In 1991, Nelson served as the negotiator for the church with the
Internal Revenue Service over whether contributions to support
missionaries serving would be tax deductible. In 1992, he served on the
Strengthening Church Members Committee, alongside fellow apostle
James E. Faust. In 1993, he was the church's lead delegate to the
Parliament on World Religions. For a time he was also the church's representative to a US State Department committee on international religious freedom. Nelson's assignments as an apostle included supervisory responsibility for the church in Africa. In 2009, he, along with his wife and others, were attacked while in
Mozambique. He also made several other visits to the continent, including one to
Kenya in 2011. From 2007 to 2015, Nelson was a member of the
Church Board of Education, the governing body of the
Church Educational System, and the chairman of its executive committee. He was succeeded as chairman of the executive committee by Oaks. Following the death of
Boyd K. Packer on July 3, 2015, Nelson became the most senior member of the Quorum of the Twelve and the quorum's president. Nelson was set apart as the quorum president on July 15, 2015, by Thomas S. Monson. Nelson made his first international trip as quorum president to Central America in late August 2015. The following month, Nelson dedicated the renovated
Aaronic Priesthood Restoration Site in Pennsylvania, where church members believe the
Aaronic and
Melchizedek priesthoods were restored. In 2016, as president of the Quorum of the Twelve Apostles, Nelson declared that the church's governing council had received a revelation from God requiring First Presidency approval before the baptism of minor children that lived with same-sex parents. "It was our privilege as apostles to sustain what had been revealed to President Monson," Nelson said. Citing "continuing revelation" and a changing global context, this policy was adjusted in 2019, such that First Presidency approval was no longer required for the children to be baptized.
Eastern Europe After Monson's call to the First Presidency in 1985, Nelson was assigned as the apostle to oversee the work of the church in Eastern Europe. In this assignment, he worked closely with Dennis B. Neuenschwander and Hans B. Ringger. Nelson was involved in the first meetings between church leaders and government officials of
Bulgaria, Romania, and the Soviet Union, and worked to continue expansion of the church and recognition efforts in
Czechoslovakia,
Hungary, and
Poland. In August 2010, Nelson journeyed to the dedication of the
Kyiv Ukraine Temple. Afterwards, in September, he traveled to church meetings in several European countries. He pronounced blessings upon
Croatia,
Slovenia,
Macedonia,
Bosnia and Herzegovina, and
Kosovo while visiting each of those countries; these serve as addendums to Monson's 1985 dedication of
Yugoslavia for the preaching of the gospel. Nelson's only son, Russell M. Nelson Jr., served as an
missionary of the church in Russia. In 2011, Nelson Sr. returned to Russia to organize the first church
stake in that country, headquartered in Moscow. While there, Nelson visited government officials, was interviewed by Yuzhnaya Stalitsa television, and dedicated that country for the preaching of the gospel. He developed ties with the medical community in China and made several trips there to train surgeons. In 1985, Nelson was the first person to be made an honorary professor of
Shandong Medical College. In 1995, Nelson went to Beijing, along with
Neal A. Maxwell and other church leaders, on an official invitation of
Li Lanqing, the Vice Premier of China.
LDS Church president With the death of Monson on January 2, 2018, Nelson became the anticipated
successor to the church's presidency. Nelson signed 1,150
mission calls as the presiding apostle. After being ordained and set apart as church president on January 14, 2018, Nelson was introduced to church members and the media two days later, along with Oaks as his first counselor and
Henry B. Eyring as second counselor. Nelson chose not to retain
Dieter F. Uchtdorf, who had served as Monson's second counselor, in the new
First Presidency. This marked the first time since 1985 that a new church president had not retained a previously-serving counselor. On April 14, 2022, Nelson surpassed Gordon B. Hinckley to become the oldest president in the church's history. On August 8, 2022, Nelson became the church's oldest apostle ever, surpassing
David B. Haight. Nelson
turned one hundred on September 9, 2024. The church commemorated his birthday with a globally broadcast livestream showcasing his life and church service.
Worldwide ministry As president, Nelson visited dozens of countries, addressing thousands of church members. His first trip—called a global ministry tour by the church—occurred in April 2018, when Nelson along with his wife, and
Jeffrey R. Holland and his wife, met with Latter-day Saints in
London,
England;
Jerusalem;
Nairobi,
Kenya;
Harare,
Zimbabwe;
Bengaluru,
India;
Bangkok,
Thailand;
Hong Kong; and
Laie, Hawaii. In June 2018, Nelson traveled to
Alberta, Canada, where his second wife was born and raised, and gave three devotional addresses in three consecutive evenings. In September 2018, Nelson visited the
Dominican Republic, where he gave an entire talk in Spanish, which was believed to be the first time a church president had given an extended talk in a formal setting in a language other than English. On the same trip, he visited Puerto Rico. On February 10, 2019, Nelson spoke to church members in Arizona at
State Farm Stadium in
Glendale. In addition to the large crowd in attendance, the devotional was broadcast across the state. On March 9, 2019, Nelson met with
Pope Francis at the Vatican. The event marked the first time in history that a pope and a president of the church had met face-to-face. The meeting took place the day before the church's
Rome Italy Temple was dedicated. In August 2019, Nelson visited Guatemala, Colombia, Ecuador, Argentina, and Brazil.
Organizational and policy changes The first few months of Nelson's leadership of the church saw many significant changes to church policy, although many had at least been heavily discussed before he became church president, and some were continuations of policies instituted by his predecessors. Nelson began his presidency two days after his ordination with a short broadcast to church members before holding a press conference. The broadcast ahead of the press conference was unprecedented and provided the new leaders an opportunity to briefly address the entire church immediately. In March 2018, the First Presidency issued a letter on preventing and responding to abuse. This letter reiterated existing policies, but also explicitly stated that no one should ever be counseled against reporting abuse to legal authorities. The guidance also had a clear emphasis on using counseling to assist in healing from abuse. It also provided more clear policies mandating all interviews with women and youth be done with another person in the general area and made it clear that youth and women could have a parent or other adult present for an interview. It also adjusted previous policies forbidding adult males to teach classes of children or youth alone to apply to all adults. During the church's April 2018 general conference, Nelson appointed Asian American
Gerrit W. Gong and Brazilian
Ulisses Soares to the Quorum of the Twelve Apostles, both of whom had been serving in the
Presidency of the Seventy. Nelson also introduced major changes in church organization during the April general conference. First, the
high priests groups at the ward level were dissolved, making all
Melchizedek priesthood holders in wards and branches part of the
elders quorum. A stake's high priest quorum now consists of current members of stake presidencies, high councils, bishoprics and functioning
patriarchs. Next, Nelson ended home teaching and visiting teaching, replacing the programs with a focus on
ministering, and shifting both the focus and methods of tracking them. As part of this change, young women ages 14–18 may be assigned as ministering sisters, similar to the-long standing policies of young men ages 14–18 serving as home teachers. June 2018 began with a First Presidency–sponsored celebration of the fortieth anniversary of
the revelation extending
priesthood and temple blessings to all worthy members without regard to race, in which Nelson gave concluding remarks. A few days before this, Nelson and his counselors met with the national leaders of the
NAACP. That same weekend Nelson gave a devotional to youth of the church, in which he urged them to more fully commit to the church. He encouraged them to collectively choose a period of seven days in which to abstain from the use of social media. On June 18, the First Presidency created committees assigned to form a unified
hymnbook and
children's songbook for the worldwide church membership, with each language edition having the same hymns (and other songs) in the same order, and that these committees would be taking submissions and collecting surveys until July 2019. It is anticipated that the process of creating the new unified hymnbook and children's songbook will take several years. On June 29, 2018, the
Come, Follow Me program was announced, changing the format for study curriculum to be "home-centered and church supported". In August 2018, Nelson issued a statement urging the use of the
church's full name. At the church's general conference in October 2018, he reiterated his position, declaring, "It is a correction" and "It is the command of the Lord." Nelson told members, "To remove the Lord’s name from the Lord’s Church is a major victory for Satan." In the October 2018 general conference, Nelson announced the shortened length of Sunday church meetings to two hours, from the previous standard of three. At the end of the month, Nelson toured five South American countries, during which he met with Peru's president,
Martín Vizcarra, gave a major address in Peru in Spanish, and dedicated the
Concepción Chile Temple. In December 2018, the First Presidency changed the process of youth class progression and priesthood ordination. Beginning in 2019, youth began moving between classes and priesthood quorums at the beginning of the year in which they turn twelve, fourteen, or sixteen, rather than when their birthday occurs during the year. In April 2019, the First Presidency reversed a controversial November 2015 policy that classified same-sex couples as apostates and required parental and First Presidency approval before minor children of same-sex couples could be baptized or receive baby blessings. Nelson had previously characterized the 2015 policy as direction from God, stating that "each of us during that sacred moment felt a spiritual confirmation . . . It was our privilege as apostles to sustain what had been revealed to President Monson." Shortly after the change, Nelson said in a press release that the reversal was, "revelation upon revelation" and intended to "help affected families" and "reduce the hate and contention so common today."
Temples Nelson's tenure as church president saw an increased focus on worship in the church's temples. As of April 2025, Nelson had announced a total of 200 new temples to be built in many countries around the world. His travels included several temple dedications, most notably the
Rome Italy Temple in March 2019, which was attended by all current members of the First Presidency and Quorum of the Twelve Apostles. In 2018, Nelson announced nineteen new temples, seven in April and twelve in October, among which were the first in
India,
Nicaragua,
Russia, and
Cambodia. During his April 2018 visit to India, Nelson stated to church members that the Lord had instructed him to announce the temple the night before general conference, though he had not originally planned to do so. With the temple in Nicaragua, Nelson fulfilled an apostolic promise he had made to church members there six years earlier. In October 2018, Nelson concluded a ten-day trip to South America by dedicating the
Concepcion Chile Temple. Following the December 2018 dedication of the
Barranquilla Colombia Temple by Dallin H. Oaks, Nelson presided over the three-day dedicatory services for the Rome Italy Temple from March 10 to 12, 2019. Nelson took all the church's apostles with him to Rome for that dedication. This was the first time all ordained apostles of the church had been gathered in one location outside the United States. While in Rome, the First Presidency and Quorum of the Twelve Apostles took the first apostolic group photo in two decades. In April 2020, Nelson announced plans to build a temple in
Shanghai,
China. Days later, the Shanghai Municipal Ethnic and Religious Affairs Bureau responded saying it "knew nothing about the American Mormon Church . . . building a so-called 'temple' in Shanghai." The bureau added that the church's plans were "wishful thinking, not based in reality." ==Personal life and death==