Close to the tipping point.

Nursing leaders play a critical role in creating and enacting a vision for collaborative practice with advanced practice nurses (APNs). In this special issue, Nancy Carter and colleagues have identified many important influences and outcomes of successful nursing leadership in the context of promoting advanced practice nursing roles. The authors make a strong case for the importance of nursing leadership to facilitate large-scale systems change, noting the multiple levels on which nursing leaders work to ensure advanced practice nursing roles are well introduced to improve patient care. Nursing leadership can move an innovation like advanced practice nursing practice forward toward the "tipping point," when the new idea takes hold and becomes socially acceptable and desired, when the early adopters have influenced the early majority and about 15 to 20% of the population have adopted the idea (Berwick 2003). In many ways our nursing leaders have achieved this with advanced practice nursing roles, and we should celebrate. APNs are now more common, and certainly members of the public are proud to speak of the roles APNs play in their health services. An idea that once captured the minds of a select few has spread, thanks in large part to the nursing leaders who had a vision, believed in an idea, fought for it and worked to embed the change in the system.