This issue covers the spectrum of this journal's subject matter. Our continuing education unit feature discusses moral distress in healthcare providers as a challenge for nursing leaders. As healthcare gets more complicated and the nursing shortage continues, it becomes more important for nursing leaders to be sensitive to the distress that our staff experiences in difficult ethical situations and to be prepared to assist the staff in processing these experiences in a healthy way. This issue also contains an interesting article about instances when healthcare providers have difficulty in respecting a patient's religious values. Culturally competent healthcare is now an expectation in our country from the perspective of patients, the public, and regulators. This article may provide a good point at which to begin a discussion with your staff regarding this important topic. The National Council of State Boards of Nursing column for this issue provides a helpful discussion of the differences between advanced practice registered nurse licensure versus certification. Given the wide differences between states on the licensure and regulation of advanced practice registered nurses, this information is important for nursing leaders to know. Lastly, we present a thought-provoking article discussing nursing leadership in regulation. As the 10th year of this journal comes to a close, it is interesting to reflect on all the changes in the nursing profession that have taken place since this journal was first published. By the time this issue arrives in your mailbox, the election will be over, and we will no doubt be in for yet more changes once a new administration is sworn in. We hope that this journal will help you keep up with the changes and give you ideas for how to approach changes in your own practice environment. As always, your questions and feedback would be appreciated.