As neonatal intensive care nurses face downsizing and/or cross-training, new opportunities are emerging for advanced practice nurses in follow-up care of neonatal intensive care unit graduates, case management, quality improvement, and community hospital care. This article identifies current issues in neonatal nurse practitioner (NNP) education as the model has shifted from hospital-based, certificate programs to graduate degree programs offered by colleges/universities of nursing. Opportunities for increasing NNP role flexibility and recommendations for bridging the transition to a 21st century education model for neonatal advanced practice nurses are also discussed. Despite the turmoil of change and uncertainty, the future for neonatal advanced practice nurses is positive. Successful nurses will master the skills of adaptability, flexibility, self-directed learning, leadership, and the provision of relationship centered care. Neonatal nursing educators must constantly monitor clinical practice and re-evaluate the curriculum to ensure the necessary knowledge and skills for successful practice can be achieved from the educational program. It is critical that faculty are cognizant of emerging trends and changing roles in the practice area. Additional learning opportunities may be required for graduates to successfully move into the next century.