Reframing professional boundaries in healthcare: a systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain

Health Policy. 2014 Aug;117(2):151-69. doi: 10.1016/j.healthpol.2014.04.016. Epub 2014 May 2.


Aim: To explore the main facilitators and barriers to task reallocation.

Background: One of the innovative approaches to dealing with the anticipated shortage of physicians is to reallocate tasks from the professional domain of medicine to the nursing domain. Various (cost-)effectiveness studies demonstrate that nurse practitioners can deliver as high quality care as physicians and can achieve as good outcomes. However, these studies do not examine what factors may facilitate or hinder such task reallocation.

Method: A systematic literature review of PubMed and Web of Knowledge supplemented with a snowball research method. The principles of thematic analysis were followed.

Results: The 13 identified relevant papers address a broad spectrum of task reallocation (delegation, substitution and complementary care). Thematic analysis revealed four categories of facilitators and barriers: (1) knowledge and capabilities, (2) professional boundaries, (3) organisational environment, and (4) institutional environment.

Conclusion: Introducing nurse practitioners in healthcare requires organisational redesign and the reframing of professional boundaries. Especially the facilitators and barriers in the analytical themes of 'professional boundaries' and 'organisational environment' should be considered when reallocating tasks. If not, these factors might hamper the cost-effectiveness of task reallocation in practice.

Keywords: Advanced Practice Nursing; Nurse practitioners; Organisational innovation; Physician–nurse relations; Professional delegation; Systematic review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Clinical Competence
  • Delegation, Professional*
  • Health Policy
  • Humans
  • Medicine / organization & administration*
  • Nurse Practitioners*
  • Nursing / organization & administration*
  • Physician-Nurse Relations
  • Professional Role* / psychology
  • Task Performance and Analysis*