Research provides compelling evidence that supports the current and future utilization of critical care nurse practitioners (CCNPs) in pivotal roles as providers of cost-effective, quality patient-centered care for critically ill and technology-dependent adults. This paper gives a historical perspective and describes the current national need for CCNPs to practice in expanded roles both within and outside the boundaries of intensive care. An existing CCNP program is described. In addition, guidelines for CCNP program development and role implementation are discussed.