According to Kershaw (2011), by changing federal policies and nurses achieving higher education and training, the nursing scope of practice will expand. This is evident thought current federal policies which are not evenly distributed across the nation, as only twenty-two states allow nurse practitioners (NPs) to practice independently. In addition too, NPs are required to comply with the following: physicians are to validate NP orders, provide care under physician billing codes and are unauthorized to order home healthcare (Poghosyan, 2018, p.44). Not only are federal laws limiting the advance nursing scope of practice, but facilities have the right to opt out of following federal policy. Opting out is evident at my current facility which is the VA hospital. NPs employed in the VA system, in regulatory states, are able to practice independently from physician supervision as well as: assess, diagnoses and prescribe. Therefore, if facilities allowed NPs a wide scope of practice, it could provide evidence for policy makers to expand the abilities for nurses. In order for this change to occur, nurses need to obtain advance degrees and specialized certifications (Kershaw, 2011). Nurses are required to be able to care for highly complex patients and the use of specialized equipment is required in higher levels of care. Nurses are required to make independent decisions, follow protocols and know how to intervene when patients are doing poorly. On my floor, the medical intensive care unit, nurses are specially trained to know how use various types of equipment, respond to emergent situations and are mostly bachelor prepared which demonstrates the critical care and advanced level of knowledge that is required for nurses to have. This level of expertise and knowledge allows nurses to assess and treat patients without delay which substantiates better patient outcomes. Better patient outcomes reduces cost and length of stay in the hospital as well as admission into long-term acute care. Therefore, it can be agreed upon that the Institute of Medicine (IOM) does describe how advance practice nursing is evolving. Only through evidenced based practice can we show policy makers and organizations that advanced degrees will make nurses more capable of producing specialized skills and knowledge to enhance the healthcare system.