The Canadian perspective, however, is somewhat different (de Leon-Demare et al., 1999). Canada followed the USA in its development of advanced practice roles. Owing to chronic shortages the Canadian government had to look to alternatives to physician-directed care. The advanced practice nurse was seen as a cost-effective alternative healthcare provider and was developed to improve access to preventive primary care, especially for the underserved, remote rural areas. This, however, led to advanced practice nurses being stigmatised as being replacement physicians. When the shortage of doctors was reversed there was a backlash against advanced practice.

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