The acute care nurse practitioner (ACNP) is a unique advanced practice nursing role that has expanded since the first national certification examination became available in 1995. This article reports on the results of year 2 of an annual survey of ACNPs as part of a 5-year longitudinal study exploring ACNP role development. Responses from 545 ACNPs 2 years after national certification reveal continued development and challenges in practice. Role components continue to highlight the comprehensive care model of ACNP practice in terms of coordination of patient care, interactions with family members, consultation, and discharge planning. Important issues identified by participants including the need for clinical experience, the importance of negotiation, and networking also are discussed.