Table 3 Example of quotes illustrating the different determinants perceived to influence task shifting implementability

Knowledge of and acceptability of task-shifting rationale

• It (the task shifting project) should be discussed with all stakeholders (…). It is not a good idea to introduce something that a group is critical towards from the beginning, as it often leads to adversity. (Nurse1)

• Task shifting must be acceptable to both groups. (Doctor2).

Dynamic role boundaries

• Solving the tasks in the best possible and most efficient way is of highest importance, who performs them is less important. (Doctor1)

• Sometimes we should stop and think, “what is actually nursing and what is our profession?” (Nurse8).

• I think that doctors should perform diagnosis (…) Diagnosing is often about ruling out a lot of stuff too. (Nurse7)

• Diagnosis and treatment – that might be our domain (…) It is easier to delegate practical things. (Doctor3)

Technical skills to perform biopsies/aspiration

• Performing bone marrow examination is a practical task (...) you do the procedure. (Nurse11)

Beliefs about consequences

• outcome efficiency

• outcome quality

• job satisfaction

• It becomes more flexible who can perform things. (Nurse4)

• Work will be more effective. There are usually more nurses than doctors at work. (Nurse1)

• We can spend more time on things that just we can perform (…) taking care of the poorer patients. (Doctor3)

• The more people that are involved with (…) a patient, the greater the risk of important information getting lost, which in turn can lead to complications. (Doctor1)

• I also think that it (task shifting) may have an opposite effect - that people will quit because they will not do it. Some think it is tough to just be here and do the job they do. (Nurse3)

• It is cool to learn something new but (...) you should have a good insight into the patient every single day. Then it is an advantage to have participated in nursing yourself. (Nurse5)

Beliefs about capabilities

• technical skills

• communicative skills

• emotional skills

• Bone marrow biopsy (...) I think we are gentler. We are more concerned with how the patient feels. (Nurse8).

Job satisfaction /Esteem

• A motivational factor is (…) the feeling of climbing a kind of career ladder and getting new challenges (…) and lots of responsibility. (Nurse8)

• It (the project) is (…) a declaration of trust. (Nurse1)

Organisational culture

• team positivity

• It is a lot about the culture in a unit (...) Culture is actually a prerequisite fo00 success. (Nurse1)

Emotions

• fear of informal nurse hierarchy

• envy

• It becomes a kind of hierarchical structure (...) because they (the project nurses) feel that they are (...) better nurses. (Nurse8)

• It must not turn into a situation where we set those tasks higher than (...) a traditional nursing job. (Nurse11)

Project planning and leadership

• Structured training

• Time to practice

• Voluntariness

• It (the project) must definitely be agreed with and followed up by management and a reasonably clear goal must be set. (Doctor2)

• You must have good training (…) Then you have to feel that you can handle it (the task) before you get the full responsibility. (Doctor3)

• A prerequisite is that training is under guidance, that those who perform it are feeling safe, and that it is voluntary. (Nurse1)

Patient preferences

• I do not think it is about profession; it is about them (patients) wanting someone who has done it (the task) many times. A patient would be equally sceptical if a young doctor appears to be very unsure of the procedure, I think. (Nurse4)