The role of the Nurse Practitioner, which began in the United States in the 1960’s, has expanded dramatically around the world.  There is a great need for development of this role to address the need for health promotion, disease prevention, and to provide for evidence based care to the underserved populations of the world. 

            As this advanced practice role is introduced into the health care environment of a country or nation state,  a clear developmental process  occurs across all settings. When one looks at the path of acceptance and utilization of the advanced practice nurse in a new location, the challenges and the responses to those challenges mirrors a developmental process.

            This discussion will outline the developmental steps that are similar for all newly introduced advanced practice roles despite the availability of historical information from other countries.  Similar to pediatric and adolescent development, even though the stages are known and are clear, the child must progress through them in order to emerge as a strong and healthy individual, so must the advanced practice, nurse practitioner role evolve through these steps in order for them to emerge as successful and vital.  

            The stages are: 1.  Identified need, 2. Special application of a few nurses to this need, 3.  Development and standardization of education,  4.  Regulatory and certification process,  5. Challenges to the role, 6.  Evidence based responses to the challenges, and 7.  Solidification of the role.  There are often additional challenges to be faced and there may be some detours along the road, but these stages are the same in each country that develops the role.  Knowledge of these stages and the role of “anticipatory guidance” to countries that are developing the role in order to prepare them to address these challenges will assist in meeting the needs of underserved populations.