The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. Also as the result of the Affordable Care Act implementation, diversity changes already occur in the health care system. Nurses like me, from old school have to adapt to the new electronic world and innovative-technologic changes. As an advanced nurse practitioner is vital to acquire the competencies and skills necessaries to function appropriate. Nurses are the front line of defense to the new challenges in the healthcare system (Wagner, 2014). Nurses contribute with the physician role, when providing quality care to the patient and family in the health care environment setting, especially in primary
