Health care around the world is transforming at a rate and in ways never seen previously. Nurses should be leading change and advancing health in an increasingly complex health system, according to the United States’ Institute of Medicine (IOM) 2011 report, The Future of Nursing. The IOM report indicates “advanced practice registered nurses (APRNs) should be able to practice to the full extent of their education and training.”1 This recommendation and the multiple systemic health care changes occurring secondary to the United States’ 2010 Patient Protection and Affordable Care Act (PPACA) make this an optimal time for full use of nurse practitioners (NPs) in ways not realized previously. This article describes the evolution and future of the NP role, explores the practice in relation to regulation and policy; primary care; acute care; inter-national, global, and cultural issues; and public image, and addresses how NPs must prepare for changing health care environments and consumer demands.