Nurses in Expanding Roles {Ans: Nurses in advanced practice, the nurse practitioners or advanced practice nurses, can provide primary ambulatory care, normal pregnancy care and delivery, and routine anesthesia at least as well as physicians. In each instance, the initial informal efforts to create a new arena for nursing were followed by the establishment of standards, formal curricula in approved programs, and, more recently, the preparation for advanced levels through master's and doctoral degree programs in universities. The development of each new form of and forum for nursing was also accompanied by a serious struggle for acceptance, especially within the medical profession. This was especially true if the new form was or could be taken to be in economic competition with physicians. (APRNs)—RNs with specialized training and advanced degrees— has risen from about 30,000 in 1990 to about 140,000 in 2010. In addition, APRNs are considered to be less rushed and more holistic in their approach to patients, factors increasing patient satisfaction. Some states allow APRNs to practice more independently and comprehensively than others. In these terms, in 2002 the following states were considered the best environments to practice as an APRN: New Mexico, Arizona, Iowa, Oregon, Montana, Maine,