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Eur J Public Health. 2016 Dec;26(6):927-934. doi: 10.1093/eurpub/ckw098. Epub 2016 Aug 2.

Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study.

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Harkness & B. Braun Fellow in Healthcare Policy and Practice, Center for Health, Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Claire Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104-4217, USA
Department of Healthcare Management, Technische Universität Berlin, Strasse des 17. Juni 135, Berlin 10623, Germany.
Claire M Fagin Professor and Director, Center for Health Outcomes and Policy Research, School of Nursing, Senior Fellow, Leonard Davis Institute for Health Economics, University of Pennsylvania, 418 Curie Blvd, Claire M. Fagin Hall, 387R, Philadelphia, PA 19104-4217, USA.



Primary care is in short supply in many countries. Task shifting from physicians to nurses is one strategy to improve access, but international research is scarce. We analysed the extent of task shifting in primary care and policy reforms in 39 countries.


Cross-country comparative research, based on an international expert survey, plus literature scoping review. A total of 93 country experts participated, covering Europe, USA, Canada, Australia and New Zealand (response rate: 85.3%). Experts were selected according to pre-defined criteria. Survey responses were triangulated with the literature and analysed using policy, thematic and descriptive methods to assess developments in country-specific contexts.


Task shifting, where nurses take up advanced roles from physicians, was implemented in two-thirds of countries (N = 27, 69%), yet its extent varied. Three clusters emerged: 11 countries with extensive (Australia, Canada, England, Northern Ireland, Scotland, Wales, Finland, Ireland, Netherlands, New Zealand and USA), 16 countries with limited and 12 countries with no task shifting. The high number of policy, regulatory and educational reforms, such as on nurse prescribing, demonstrate an evolving trend internationally toward expanding nurses' scope-of-practice in primary care.


Many countries have implemented task-shifting reforms to maximise workforce capacity. Reforms have focused on removing regulatory and to a lower extent, financial barriers, yet were often lengthy and controversial. Countries early on in the process are primarily reforming their education. From an international and particularly European Union perspective, developing standardised definitions, minimum educational and practice requirements would facilitate recognition procedures in increasingly connected labour markets.

[Indexed for MEDLINE]

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