The advanced practice registered nursing must have knowledge of and the ability to create the systems of care that will ensure the high quality and cost effective care needed in the future. Many factors are involved in understanding organizational influences that affect the advanced practice registered nurses (APRNs) roles and functions. Advanced knowledge in such fields as organizational behavior, cost analysis, risk management, patient satisfaction, safety, and quality is necessary to fully implement the role of the APRN. APRNs must develop the knowledge to analyze organizational variables and the skills and abilities to enhance quality and safety. To ensure that the APRN is on the forefront of new and innovative care delivery practices, an understanding of the healthcare systems and organizations that are and should be in place where the APRN practices is a needed prerequisite.