Advanced practice nurses (APNs) have been described as “invisible champions.”11 The APNs who are employed in the critical care division at Children’s Hospital of Pitts-burgh of UPMC function as clinical nurse specialists. They have enacted APN subroles to advance numerous initiatives in collaboration with professional staff nurses and other disciplines exerting influence across the organization (see TableT1).

Trying to grasp what APN roles look like as they develop around the world has been likened to watching a “whirling dervish.”22 Confusion over job titles prevails and scopes of practice are unclear or unstated. Even with the best intentions, national health care leaders struggle with making APN initiatives succeed.22 At times, there is more volatile debate over what title to assign this category of nurses than there is constructive discussion over its scope of practice and integration...

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