Advanced Nursing Practice Schober, Madrean and Affara, Fadwa , 2006 ; International Council of Nurses/Blackwell Publishing ; paperback, 223 pages. ISBN: 139781405125338 . How do you define and describe something as ubiquitous, and yet as elusive, as Advanced Nursing Practice (ANP)? Schober and Affara have risen to this challenge on behalf of ICN. They provide an essential guide on the extent of this phenomenon globally, and in terms of practice, education, regulation and research. Their reach in documenting what is going on in ANP is phenomenal. Nurses everywhere will find in this book the evidence to confirm what they may have felt only intuitively: the scope of ANP, whilst extremely broad, is associated with common core competencies irrespective of where it is carried out and/or what it is called. So far, so good; however, the picture that Schober and Affara provide can only be a cross section or a snapshot of a rapidly changing situation. They quote evidence to show that ANP in hospitals and in primary health care settings everywhere involves delegation from physicians, and that Advanced Nursing Practitioners ‘can provide care at least equivalent to doctors in defined situations’ (page 51). The difficulty, as I read it, is that this has been the case for at least a century or more, and will almost certainly continue to be so. For example, I understand that procedures such as urine testing, the taking of temperatures and blood pressures were all once the province of physicians, but now they are unquestionably accepted as the responsibility either of nurses, or care assistants. As health technology develops at an astonishing speed, this continuous delegation to others can only accelerate. Nurses have led the way in trying to document and control this phenomenon of labour substitution. They have tried to expand their extended roles so that what they perceive to be unique to nursing (frequently called ‘caring’) becomes incorporated into what otherwise might be purely technical tasks. Schober and Affara’s guide to ANP at the beginning of the 21st century is a part of this nursing documentation. Other practitioners are now joining nurses in this quest for definition and for some reassurance of future certainty in their health care roles. In the United Kingdom, government policy makers and planners have wrestled for more than half a century with ever-increasing costs in a National Health Service (NHS) ‘free at the point of delivery’. Questions about the economics of labour substitution are part of everyday health care policy discourse. The publisher Palgrave Macmillan is producing a series of ‘futures’ texts on health care organizations and labour. One in particular, The future health workforce (Davies 2003) considers in a series of essays, all the changes in context and setting that have involved the redrawing of boundaries within and across the health professions. When I read this, I felt that since nurses have been ‘ahead of the game’ in documenting the constants that remain in their ever-changing roles, so now they must engage with others in these wider debates. For what will be nurses’ response when others claim that ANP core competencies are not unique to nursing? Exactly this scenario occurred in the 1960s when British health visitors defined their role and function (CETHV 1967). Others claimed that the role was defined in such broad terms that it could apply to almost any health care practitioner. These comments are intended in no way to devalue the contribution that Schober and Affara have made in producing this guide. Rather, they are intended to challenge nurses to read the book, and then to ask ‘What next?’ This is the issue raised at the end of Advanced Nursing Practice. The authors ask ‘. . . does this phenomenon represent an identity crisis for nursing with a risk that pursuing it further will lead to professional confusion, or is it a sign of nursing progressing and responding to current and future health care demands?’(page 165). Only nurses can and should contribute to this wider debate that must surely run for the foreseeable future. The book is available from: ICN’s online bookshop, http://www.icn.ch/bookshop.htm; http://www.blackwellpublishing.com; and at Amazon’s UK and USA sites.