This study examined the nurse practitioner (NP) role in three long-term care facilities in Ontario, Canada, to identify factors that facilitate or impede the implementation of this role. Facility staff were surveyed about their perceptions of the NP role, and the NP assigned to the facilities was interviewed. Findings indicated the NP had a positive impact on practice activities and staff assessment skills. Ratings of effectiveness and satisfaction with the role were high, although they varied by facility and the frequency of staff interaction with the NP. This study indicated NPs can significantly impact the primary care of residents in long-term care facilities. The NP role can be facilitated by clear delineation of the scope of practice, optimal NP to resident ratios, and organizational support.