The focus on advanced practice is now critical, as the nation begins to reform our health care system. President Clinton has called for a plan that incorporates “security, simplicity, savings, choice, quality, and responsibility”. These are major efforts for health care providers, including nurses who deliver direct care and designers of these health care systems. The future work of the advanced nurse practitioner evolves from today's practitioners and their vision. Now, nurses in advanced practice can help design and implement systems of the future. The author highlights some of the issues involved in advanced practice, remarking on how advanced practice might be implemented in the critical care setting. The specifics of implementation is the responsibility of specialists in acute care. As a primary care nurse practitioner, the author provides ideas of application and examines some of the barriers to the continuing growth of nursing practice.