Susie is an FNP working in a rural health clinic. She established her practice in a state that ranks poorly in the area of advanced practice regulation when combined with healthcare service need (Lugo, O’Grady, Hodnicki, & Hanson, 2007). Susie’s patients are primarily low-income families with limited education. Prior to Susie moving into this largely rural farming community, there was no medical care available in the area. Community members had to drive at least one hour or longer to be seen for healthcare concerns. The state is known for its poor access to healthcare and poor quality of health, making the clinic Susie established eligible as a rural health clinic. Most of the patients seen in the practice have common clusters of diagnoses, including diabetes, hypertension, and obesity. In the following vignettes, we will follow Susie at her rural health clinic for one week in order to get a glimpse at how she demonstrates application of the HRSA (2002) NP primary care competencies. The first HRSA (2002) area of NP primary care competencies for the FNP is focused on skills, understandings, and integrative abilities related to health promotion, health protection, disease prevention, and treatment. On Monday, Susie assessed one maternal-child dyad (two weeks), assessed one pregnant teen (24-weeks gestation), performed four high school sports physicals in which she took time to encourage these healthy teens to implement aerobic exercise (health promotion), gave a series of immunizations to two infants and three children (health maintenance), restored health to five patients who presented with sinusitis, and treated six patients with hypertension (disease prevention). In this area, the expectation is that Susie demonstrated advanced practice nursing knowledge regarding assessment and diagnosis of health status as well as advanced practice nursing knowledge necessary to plan for implementation of treatment strategies. On this busy clinic day, Susie was able to provide direct care services to a wide variety of age-related patients as well as population specific, with particular attention to the family unit in FNP specialty practice. Another HRSA (2002) area of NP primary care competencies for the FNP is focused on skills, understandings, and integrative abilities related to the nurse practitioner-patient relationship. On Tuesday morning, Susie has a patient present with what she believes to be a navicular fracture of the hand. In this area, the expectation is that Susie demonstrates a synthesis of personal, collegial, and collaborative behaviors across diverse settings, so she contacts a colleague who specializes in hand orthopedics, and she arranges a consultative referral for her patient. In so doing, Susie has demonstrated that she is able to utilize interpersonal transactions to effectively communicate and partner with multiple stakeholders in FNP specialty practice. The next HRSA (2002) area of NP primary care competencies for the FNP is focused on skills, understandings, and integrative abilities related to the teaching-coaching function. On Tuesday afternoon, Susie has a post-partum visit with a new mom. The mom is upset because her baby does