The DNP is acknowledged as a nursing practice doctorate and has been developed to create expert nurse clinicians regardless of nursing role. The DNP degree is a huge accomplishment for the nursing profession. Doctoral degrees included in the literature encompass DNPs, PhDs, and EdDs as well. The DNP project is the pinnacle for completion of the degree. Much like the nursing profession, there is not a standardized terminology for the project. The DNP opportunities are boundless and will build upon the fundamentals of nursing practice. This chapter provides an overview of the evolution of the DNP degree, different programs, and learning environments available. In addition, it is hoped that this chapter will create a vision for potential personal and professional options offered with pursuing the degree. Choosing the DNP degree will enhance multiple opportunities to open pathways in nursing that are not always available without a terminal degree.

Education loans for advanced nursing degrees come in the following categories: Federal Direct Unsubsidized Student Loan; Federal Direct Grad PLUS Loan; Nursing Student Loan; and Private Education Loan. Federal Direct Student Loans are a form of financial aid that must be repaid with interest. Grad PLUS is a federal loan also funded by the Department of Education; its benefits are similar to those of Federal Direct Loans. Students should check with the financial aid office of their institution to determine whether the institution offers its own nursing student loan program. Private education loans are nonfederal loans made by a private lender such as a bank, credit union, or state agency, and there are no federal forms to complete. Graduate students who consider using private education loans often also consider using a personal residence or home equity loan to finance their education. Borrowing from retirement accounts also may be considered as a source for college funding.

A pivotal strategy to improve the quality of health care while lowering costs in the United States is value-based purchasing (VBP). Advanced Practice Registered Nurses (APRNs) can lead this transformation through collaboration, coaching/mentoring, direct patient care, research, ethics, and leadership. To achieve success in improving patient safety and outcomes, leaders must focus on interprofessional, team-based collaboration to effectively lead all involved to system and process improvements in the delivery of care. APRNs should also take professional accountability to become knowledgeable about the Affordable Care Act and VBP, not just the program that applies to the APRN’s practice but about all programs, and discuss these with other providers, colleagues, and patients. Finally, APRNs must also become involved in policy making to remove barriers for all nurses and to allow APRNs to practice at their highest level of education, skill, and competency.

Older adults represent a segment of the population that has the greatest dependence on government policies, whether they are national, state, or local. Advanced Practice Registered Nurses (APRNs) who care for this population need to understand the impact policy has on the health care and daily lives of their older patients. These policies also impact the practice of APRNs and may erect barriers that prevent the provision of the quality of care that they have the skills and training to provide. This chapter presents a demographics of adults over the age of 65, a review of key legislation, and discussion of strategies to take advantage of opportunities to participate in the policy process. Having health care covered by Medicare and Medicaid is a key to the health of older adults, but there are other social determinants of health that require adequate resources.

This chapter outlines the historical perspective on the advancement of the compact licenses, how this could benefit the profession and what next steps should be taken. The Advanced Practice Registered Nurse (APRN) compact is newer on the scene in terms of full enactment, but it has also been a part of the discussions about APRN practice since the initial discussions of registered nurse practice and the interstate compact in 2015. Conceptually, the APRN compact makes sense and takes the APRN Consensus Model document and moves it to a new level in that the proposed regulatory language includes a nod to the Consensus Model language. The actions and activities of the APRNs, the patients, and the employers have a role to play in the full implementation of the compact. Each APRN has to weigh and measure the need for the compact in their personal practice.

Improving and updating the health care system in the United States have been on the agenda of legislators, regulators, and other policy makers as well as health care providers for decades. In the Obama administration, health care reform legislation was undertaken and the bill was called the Patient Protection and Affordable Care Act (PPACA) of 2010. It has provided significantly increased opportunities for Advanced Practice Registered Nurse (APRNs) to practice to the full extent of their education and licensure. It is important for APRNs to continue to take advantage of the opportunities provided in the PPACA and its subsequent iterations by seizing the moment to demonstrate their worth and expertise in meeting the health care needs of the nation and to continue to use their influence to make changes in the country’s health care system that will improve the health and welfare of its citizens.

Healthcare systems in the United States rely on health policy regulation to ensure that the appropriate amount of consideration is given to the quality, access, equity, efficiency, cost, and defragmentation of their professional practices. One of the most major health policies in decades, the 2010 Patient Protection and Affordable Care Act (ACA), increased both health insurance coverage for Americans and access to care. Health care systems must also continue to be cognizant of new and evolving regulatory guidance and rules in addition to federal and state laws. Healthcare professionals and those who are responsible for health care administration need to be cognizant of the entire legal environment. This chapter presents the current policies and regulations that have helped shape and transform Advanced Practice Registered Nurses (APRN) practice in healthcare systems and how APRNs can shape future policies and regulation to continue to transform practice in healthcare systems.

Certified Registered Nurse Anesthetists (CRNA) are advanced practice registered nurses (APRNs) licensed as independent practitioners who plan and deliver anesthesia, pain management, and related care to patients of all health complexities across the lifespan. The early leaders of this profession were amazing women who taught so many lessons that resonate today. CRNAs, and all APRNs, have a key role to play in the development of our nation’s health care policy. Nurse anesthetists must be willing to challenge the system when it is in patients’ best interests to do so while understanding that health care spending competes with other important needs of society, and efforts to reduce costs mean better access to care for all. The future is bright for this storied profession as health policy incentives align to reward the value that CRNAs bring to the patient experience.

Nursing is at a crossroads worldwide, as key decision makers increasingly recognize that achieving successful health care systems for the future rests on the future of nursing. The growing presence of Advanced Practice Registered Nurses (APRNs) suggests that nurses in these roles provide leadership in achieving accessible, high-quality care, and expertise. This chapter focuses on events or policies that have impacted the development of APRN roles internationally and aims to demonstrate the complex nature of health policy processes and various courses of action that have influenced role development worldwide. It begins by providing an international contextual background for advanced practice nursing. The chapter describes specific health policies, processes or actions that have supported or impeded APRN practice. It also provides illustrations of achievements in specific countries or regions of the world portray the significance health policy has on role development.