This report was commissioned by OECD to examine the evidence on role change and delegation from physicians to advanced practice nurses (APN)- nurse practitioners and nurses in other advanced roles in the hospital setting and primary care. The report has three components: - a literature review, an assessment of country responses to an OECD questionnaire, and two more detailed country case studies, on England and US. The policy focus on cost- containment, quality improvement and efficient use of human resources in health care increased the need to identify the most effective mix of staff within the resources available. Workforce shortages and changes in regulations and legislative reform (such as the European Working Time Directive, and legislation to enable nurses to prescribe) have also been drivers to investigate or initiate new roles.  The review concluded that the evidence base, although limited, does support the view that nurses can provide care at least equivalent to doctors in defined care environments, although the full cost/benefit implications of this are not clear with the data currently available. 

 James Buchan and Lynn Calman/ 2004