Urgent and compelling health challenges are facing the world's populations, including aging populations; virulent, fast-spreading infections; and high rates of diabetes and other noncommunicable diseases. At the same time, the crescendo in the calls to action to reduce inequities are in response to different and equally detrimental threats to health: racism, colonialism, and discrimination. These health challenges are compounded by barriers to care, especially for rural and remote communities and marginalized populations in urban areas. In response, more and more countries around the world are looking to nursing, particularly advanced practice nursing, for solutions to these shortfalls.

Advanced practice nursing roles require graduate-level education, are characterized by a scope of practice that is beyond that of a generalist or specialized nurse, and often include knowledge and skills that overlap with other health care professionals. Whereas advanced practice nursing roles have been in place for several decades in some countries, in many other countries their introduction is much more recent. The World Health Organization, International Council of Nurses, and Nursing Now's State of the World's Nursing 2020 report found that 78 of 191 countries surveyed had advanced practice nursing roles.1 Considering that a 2008 survey reported 32 countries with advanced practice nursing roles,2 the global growth in the introduction of these roles is remarkable.

Research has been vital to the evolution of the advanced practice nursing role over the past 50 years. Much of this research originates in North America where the roles have been implemented for the longest time. The United Kingdom, Europe, Australia, and many other countries have also been frequent contributors. Examination of the contextual factors influencing the implementation of advanced practice nursing roles-including, for example, the scope of practice, regulation, and deployment, as well as health system governance and policy structures within each country-is a key area of research. Another critical focus is the evaluation of the outcomes of advanced practice nursing roles.

The magnitude of the body of literature describing and evaluating advanced practice nursing roles is vast and has necessitated the need for systematic approaches to charting and analyzing data sources to address important questions unanswerable in a single study. Three articles in this special issue, two of which are scoping review protocols3,4 and one a scoping review,5 address review questions that investigate several aspects of the implementation and sustainability of advanced practice nursing roles.

Almukhaini et al.3 outline a protocol for a scoping review of advanced practice nursing roles in Arab countries in the Eastern Mediterranean region. Although advanced practice nursing roles were introduced in one country in this region almost 30 years ago, it is only more recently that these roles have been introduced more widely. The review will address questions about how advanced practice nursing roles have been developed and implemented; what the role regulations, titles, and entry-level education are; and what outcomes related to these roles have been identified in the Eastern Mediterranean region. In another article, Schlunegger et al.4 outline a scoping review protocol to chart the competencies and scope of practice of nurse practitioner roles in primary health care. The review will inform the introduction of the nurse practitioner role in Switzerland, where it is being piloted. Finally, Hankins et al.5 report on a completed scoping review of the literature mapping the evidence related to professional advancement programs for advanced practice nursing roles. Nine articles were included, all based in hospitals in the United States. The small number of advancement programs found in the review had few commonalities and most had not measured outcomes such as role satisfaction and retention.

With more countries seeking to introduce and implement advanced practice nursing roles to improve health and health services for the world's populations, the need for an evidence-informed approach to role implementation and evaluation that aligns with and responds to patient and population health needs has never been greater.6 Evidence from studies examining newly introduced and implemented roles is needed to inform the structures and processes necessary for optimal implementation of advanced practice nursing roles in countries around the world. The recently released definitions of terms related to advanced practice nursing developed by the International Council of Nurses should help to address the confusion related to terminology that has hindered cross-country understanding and comparison.7 Advanced practice nursing roles improve the health outcomes of disadvantaged and under-served patient populations and increase the accessibility and quality of health services. Moreover, they contribute to the achievement of several UN Sustainable Development Goals including the following: 1) No poverty, 3) Good health and well-being, 4) Quality education, 5) Gender equality, 8) Decent work and economic growth, 10) Reduce inequalities, and 17) Partnerships for the goals.8 Systematic, patient-focused, evidence-based approaches to advanced practice nursing role implementation and evaluation can inform country-level and global policy that enables these roles to achieve intended improvements to health and health care.

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