Despite descriptions of nurse practitioner (NP) implementation, there is little guidance for health authorities on how to address the evolving and ongoing challenges of implementing and sustaining NP roles and practice, particularly in rural and remote communities where recruitment and retention are difficult and professional supports may be limited. This article describes a pathway through which NPs have been recruited, supported and retained in their practice in a large rural and remote health authority. The pathway's main steps were the creation of an NP lead for the health authority and the facilitation of conversations with NPs, which resulted in a new organizational model and a renewable action plan for recruitment and retention. The results are a strong NP leadership presence within the health authority, formalized role implementation within the medical staff structure, sustainable mechanisms for professional support, operational management and the strategic development of the NP portfolio. The experience of implementing and integrating the primary care NP workforce in rural and remote settings through an articulated pathway has provided insights into effective NP integration and sustainment in rural primary care settings.