An informal coalition of nurses, educators, health care providers and policy makers recognizing that administrative rules for advanced practice registered nurse (APRN) practice limited consumer access to care in Hawai'i, developed an initiative to bring about legislative and regulatory change using the National Council of State Boards of Nursing APRN Scope of Nursing Practice and Standards Related to the APRN. The authors report on the process including challenges and keys to success toward the passage of Hawai'i Act 169 (2009). The authors also discuss key components of the legislation, which removed barriers to full scope of practice for APRNs. The potential for comprehensive reform was realized due to the actions of a broad coalition in support of increasing access to care for underserved and rural populations in Hawai'i.