Advanced nursing practice in the USA: new directions for NPs

The demand for nurse practitioners (NPs) continues to increase in the USA and, as a result, the NP role is expanding. Originally, NPs were primarily based in the primary care arena; however, they are now filtering into secondary and tertiary healthcare settings, bringing with them advanced clinical skills. This has led to many clinical nurse specialists undertaking NP programmes. American nurses are now calling for a merger of these two roles and for changes in NP training programmes that will prepare practitioners for work in secondary and tertiary care environments as well as primary care settings. British nurses continue to examine the perimeters of advanced nursing practice; however, the realms of secondary and tertiary care should not be neglected, but rather incorporated into these developing roles and educational preparations.