a certain role, basically very much focused on the diagnosis and treat-ment. When you get into the true population health community devel-opment perspective, they lack…. What the master’s brings to people is the complete picture. I’ve noticed sitting in with a few different nurse practitioners when I was doing my own education to see the difference, and I saw a total difference between a master’s-prepared and a certificate-prepared [NP] just in how they approached it, the completeness they brought to the interaction with the patient and the follow-ups.Many educator, regulator and administrator participants and some govern-ment participants talked about the legitimacy and credibility graduate education provides. Some linked graduate education with the ability to practise autono-mously with a broad scope of practice. The following quote illustrates this. Primary care is clearly recognized across the country as a significant prob-lem.… So on the advice of many we positioned our primary care nurse practitioners to have a very wide prescriptive and diagnostic authority, which meant they had to have a really rigorous education program at the master’s level.
68 Nursing LeadershipVolume 23 Special Issue • December 2010In contrast, other interview participants indicated that the push to move PHCNP education to the master’s level was misguided. Although intended to benefit NPs, it was unlikely to improve patient care or healthcare system efficiency. Some government informants stated they did not support graduate education for PHCNPs because it was unjustified by evidence. The longer program reduced the number of NPs in the system, and the higher tuition costs were likely to lead to higher salary demands by NPs, without concomitant increases in their accessibility and number of patients served. While not arguing against graduate education, several authors (CNPI 2006; Schreiber et al. 2005a, 2005b) identified that the requirement of graduate educa-tion for PHCNPs was a concern for northern jurisdictions because of the limited access to graduate education in rural and remote communities. This is an important concern since only 5.9% of all registered nurses practising in rural and remote areas are APNs (Stewart et al. 2005). Although master’s NP program-ming is available by distance education from several universities, accessibility has been confounded by other factors such as competing demands in the workplace, technological challenges and other difficulties related to geographical remote-ness (CNPI 2006; Tilleczek et al. 2005). Our interview participants also identified the importance of distance education for both CNS and NP roles, explaining that family and financial obligations limited their mobility, and voiced similar concerns about the accessibility of educational programs. Despite these challenges, some northern jurisdictions indicated they envisioned having at least one PHCNP in each remote community by 2010 (Northwest Territories Health and Social Services 2004). In addition to distance education, another strategy some north-