The Issue
Faced with physician shortages, long wait times for patients, and high costs, health systems around the world are increasingly reassigning certain procedures normally performed by physicians to nurses with advanced training. For a study published in Health Policy, researcher Claudia Maier, a 2014–15 Harkness/Braun Fellow, examined how “task-shifting” is managed in different countries and assessed the implications of various governance models on patient safety and clarity of clinician roles.
What the Study Found
Three task-shifting regulation models were found among the 11 high-income countries studied: national, decentralized, and no regulation. The U.S. takes a decentralized approach, with individual states regulating the scope of practice for nurse practitioners. In the United Kingdom and Finland, regulation of titles and practice scope is left to employers or health care settings. Ireland, Australia, New Zealand, and the Netherlands regulate at the national level, yielding higher levels of standardization in scope of practice and, possibly, greater clarity of nurse practitioner roles compared with decentralized and nonregulated systems. No evidence was available to measure the implications of the different models on patient safety and malpractice.
Policy Options
Periodic reviews can help ensure that governance laws are up-to-date. In addition, standardized educational and practice-level requirements may reduce variation and ensure quality in care.
