Conclusions
The process required for the successful implementation of
APN roles is as complex and dynamic as the roles themselves.
The PEPPA framework articulates steps and strategies for
role implementation that are relevant to APNs and their work
environments. Engaging stakeholders in the process gives
opportunities to establish the need and identify shared goals
for a clearly-defined APN role. The framework promotes
increased understanding of APN roles and optimal use of
APN expertise. Effective planning and implementation strategies
create environmental conditions necessary to support
APN role development and long-term integration. The goaldirected
and outcome-based process also provides the basis
for prospective evaluation, and thus continued improvement
of the APN role and delivery of health care services.