The adult-gerontology acute care nurse practitioner (A-GACNP) engages in all levels of care within the acute care setting. The postanesthesia care unit (PACU), a specialized entity within the acute care environment, encounters patients at their most vulnerable through various stages of awakening. The evolving state in the health care system today creates opportunity for innovations in the hospital setting that have yet to see the advantages of the nurse practitioner. The A-GACNP possesses the education, training, and skill necessary to treat patients in the critical stages of recovery from anesthesia. This article provides the rationale for incorporating the A-GACNP into the PACU. A systematic review of the literature will examine the benefits of the nurse practitioner in the acute care setting, the A-GACNP competencies, and propose a transformation of care in the PACU where the A-GACNP has an exclusive role.