5. Review findings across country income levels.

Findings		HIC (No. of studies)	LMIC (No. of studies)
1	Recipients of care had mixed views about the expansion of tasks undertaken by nurses. They preferred doctors when the tasks were more 'medical' in nature and they accepted nurses for preventive care and follow‐ups.	12	—
2	Doctors in most studies also preferred that nurses performed only non‐medical tasks.	14	2
3	Nurses were comfortable with, and believed they were competent to deliver, a wide range of tasks, but particularly tasks that were more health promotive/preventive in nature.	12	1
4	Recipients of care in most studies believed that nurses were more easily accessible than doctors.	8	2
5	Both doctors and nurses saw doctor‐nurse substitution and collaborative practice as a way of increasing quick access to care for certain tasks such as maternity care and prescriptions.	6	—
6	Recipients of care in most studies were satisfied with nurses' social skills. Recipients' perceptions of nurses' technical skills were mixed.	14	3
7	Health professionals, including doctors, nurses, policymakers and other healthcare providers, believed that doctor‐nurse substitution led to improvements in the quality of care.	12	2
8	A close doctor‐nurse relationship characterised by trust and mutual respect helped nurses to expand and develop their roles.	9	2
9	Nurses might find it difficult to communicate effectively with colleagues in stand‐alone practices or vertical programmes of care.	3	2
10	Doctors' trust in and acceptance of nurses was a critical factor that shaped the extent of nursing practice.	15	3
11	Financial issues might damage the relationship between doctors and nurses.	6	—
12	Nurses felt they had gained additional skills through task‐shifting. However, they believed that further training and education could increase their skills, job satisfaction and motivation; allow them to work more independently; and increase others' acceptance of their professional roles.	14	5
13	Nurses had concerns about their training in terms of adequacy, equity and quality.	6	3
14	Recipients of care in many studies had limited knowledge about nurses' roles in primary care, nurse models of care and any differences between nurse‐led and doctor‐led care.	6	1
15	Doctors in some studies felt that doctor‐nurse substitution improved the continuity of care and believed that recipients of care would prefer to see the same nurse rather than different doctors.	2	—
16	Recipients of care in some studies were concerned over the continuity of care provided by nurses and felt insecure if they lost contact with their doctors.	3	1
17	Internal motivations most frequently cited by nurses regarding task‐shifting were psychological (including personal development and being respected) and professional (improving the quality of care).	11	2
18	Nurses believed that external motivations such as improved working conditions and financial incentives could act as an incentive to take on more responsibilities.	7	2
19	Doctors valued the contribution of nurses in collaborative practices when this reduced their own workload.	11	1
20	In settings where a proportion of doctors' revenues came from fee‐for‐service payments, doctors expressed negative reactions towards doctor‐nurse substitution.	3	—
21	A shortage of resources, including human resources, equipment and supplies, and lack of equity in how organisational resources were allocated, sometimes negatively impacted on the effective implementation of doctor‐nurse substitution strategies.	8	8
22	An appropriate referral system for recipients of care was important for the effective implementation of doctor‐nurse substitution strategies.	3	1
23	Experienced leadership was a facilitator of smooth implementation of doctor‐nurse substitution strategies.	5	1
24	Nurses and recipients reported dissatisfaction with the huge number of documents and reports that needed to be completed in connection with doctor‐nurse substitution strategies.	1	2
25	Clear role definitions were critical in the successful implementation of doctor‐nurse substitution strategies.	13	—
26	Where nurses were supervised by doctors, the quality of this supervision was central to the building of confidence in both partners.	6	2
27	Nurses in LMIC settings appeared to lack effective supervision.	—	2

HIC: high‐income country; LMIC: low‐ to middle‐income country.