Still spending dollars, still searching for sense: advanced practice nursing in an era of regulatory and economic turmoil.

Regulatory and market forces are dramatically affecting the practice prospects for advanced practice nurses (APNs). Examples include the designation of APNs as primary care providers by for-profit capitated systems, the elimination of "geographic" practice boundaries by the advent of telepractice, and the revision of governmental reimbursement provisions for entire categories of APNs. Educational, political, and economic challenges necessitate an increased APN leadership role in national and state policy reform efforts.