The nurse practitioner’s role in anesthesia (NPA) involves many different dimensions that are often dictated by economic factors and based on historical evolvement. In Finland, nurse anesthetists were practicing as a team with the physician anesthetists (PA) until a huge education reform limited their scope of practice. Solo practice is common in the USA and creates opportunities for private practices. Others, like Laos and Somaliland are struggling to provide sufficient care and NPAs are trained with help of neighboring and other countries. After training, their struggle continues in obtaining equipment, drugs, and support. France and Iceland are two great examples of the anesthesia team care model. NPAs working together, with indirect or direct support from PAs. NPAs in Indonesia and Morocco are providing care in a similar fashion, but due to a lack of PAs, indirect support is often the model of care. In some parts of the world, certain surgical care is not available and is provided with the help of Mercy Ships, where NPAs play an important role in providing the essential care for the local population. A solid nursing experience, adequate anesthesia education, simulation training, and official national licensure form the cornerstone of all these NPAs’ practices.