Born out of the physician shortage of the 1960s, the nurse practitioner role seems to have come full circle with the recommendations of the Institute of Medicine and Robert Wood Johnson Foundation's 2010 report on the future of nursing. The report states, "the healthcare system needs to tap into the capabilities of advanced practice nurses to meet the increased demand for primary care." But there's a major difference this time. The report also recommends that advanced practice nurses take a larger and more independent role in leading change and advancing healthcare. By continuously expanding their roles, proving their competency and pushing the barriers of acceptance and authority for more than 45 years, nurse practitioners have not only earned a place at the leadership table, they have found more ways to practice.