An increasing number of nurse practitioners are employed in in-patient settings, including emergency rooms, medical, surgical, OB-GYN and critical care units, and nursing homes. This trend poses special problems and opportunities for the in-patient practitioner in educational preparation, credentialing, employment negotiations, prospective reimbursement, hospital privileges and relationships with nurses and physicians. The differences for in-patient practitioners in these areas as opposed to those in ambulatory practice are discussed, and suggestions are made for anticipating and dealing for them.