The role of the Neonatal Nurse Practitioner has been evolving since the early 1970s. The original concept and design was born out of individual hospital's needs for highly professional and skilled personnel at the bedside. Thus, initial programs were hospital-based and granted certificates. Over the past 20 years, a gradual shift toward graduate degrees and standardization of programs has been seen. The role and responsibilities of the neonatal nurse practitioner have also expanded over that time period. From their strictly clinical beginnings, neonatal nurse practitioners now contribute to research, nursing and medical education, and administration. This article looks at the neonatal nurse practitioner role and the impact that education and legislation have had on its evolution.