Reflections on the continuing evolution of advanced practice nursing

While the concept of advanced practice nursing (APN) is still relatively new, distinct patterns of evolution from specialty practice to advanced practice nursing are evident over the last 100 years. The purpose of this article is to describe 3 stages in this evolutionary process, as well as discuss several internal and external issues that represent challenges facing APN educators and clinicians who seek to strengthen advanced practice in the current healthcare system. We clarify our definition of advanced practice nursing, and note the critical need for cohesion within the profession regarding the definition and core competencies of advanced practice. Our aim is to suggest a preferred vision for advanced credentialing. We encourage dialogue among our nursing colleagues to move this agenda forward.