Table 2.

Data excerpts and category classification

Data excerpts	Code	Subcategory	Main category
I work on a dementia special care unit, with 12 beds, and on unit for patients with chronic physical disabilities, also with 12 beds. I'm the medical contact person (PA 2.4)   2 years ago, the board of directors asked all the practice nurses to follow a specialization course at bachelor level, so we all did that. My specialization is care for patients with diabetes mellitus care and nutrition (practice nurse 4.2)	Working at a unit	Unit vs organizational level	Variation in skill mix change
	Having a special area of expertise at the organizational level
On the medical domain, we re‐invented the wheel, shaped by the elderly care physician who supported me. We have made a delineation of health‐care problems that I am allowed to treat (NPs 1.4)	PA: complex medical tasks	Levels of complexity of tasks
	NPs: medical tasks varying from “according to protocols” to “complex”
	RNs: Nursing task and supporting ECPs in medical tasks
We call or meet ad hoc if they (NPs or PA) want to show or ask me something. When you have a personal connection, interaction is easier. I have been trainer of 4 people, and sometimes this goes well and sometimes it does not go well (ECPs 3.7)	One vs more ECPs	Variation in collaboration with ECPs
	Structural versus ad‐hoc meetings
	Working alone versus working in partnership
	Peer consultation vs supervision
	Collaborative agreement
	Trust
Actually, in our medical team, the idea prevails that the elderly care physician I work in partnership with and who is my supervisor has the final responsibility for everything I do, while in practice, because I work very independent(ly), I'm responsible for everything I do. Actually, I only give it (responsibility) to him if I ask him something or ask to observe something along with me (NPs 1.2)	Legal consequences	Different ideas about responsibilities
	Final responsibility
The vision and the spot on the horizon, that was a barrier for me, especially in the beginning, because there was no spot on the horizon (NPs 1.4)	Employment by coincidence	Lack of a vision	Factors contributing to variation
	Vision not a priority
	Conservative standpoint The Dutch association of ECPs
Most practice nurses need 3–4 years to eliminate resistance, because actually every nursing assistant or nurse wants to talk to a physician and not to his assistant (practice nurse 4.3)   Sometimes I fall on my face terribly. If I, for example, want to consult a cardiologist in our hospital, then I do not even get him on the phone, as the assistants, the people of the outpatient clinic, have the instruction to only forward the call if it is a physician (NPs 1.6)   We are educated to think and act like a physician. We are all physicians, it is in our name, and NPs are often employed on a certain specialism (PA 2.5)   I think a PA fits better in the hospital, in medical unit care. (NPs 1.3)	Unfamiliarity	Lack of acceptance
	Struggles in daily practice
	Issues related to the domain of the other professionals
I have to say, like you said, it (physician substitution) differs from physician to physician, how open they are to it (physician substitution), I see that too at our place (ECPs 5.1)	Personal characteristics and ideas of ECPs	Personal factors
	Personal characteristics and ideas of NPs
	Personal characteristics and ideas of PA
You have more continuity. Indeed, medical residents, a year, then they are gone (ECPs 3.6)   We (NPs) have a broader view. I always give the example: a baker who does not want to sleep anymore at 6 o'clock in the morning, because he is used to wake up at 4 o'clock for 40 years….Then you can give him pills (sleep medication), but I think you have to go where the patient goes, and you have to involve the night shift, give that man something to do….Then you see that our view differs from the view of a physician. A physician would prescribe medication more quickly, so to make him sleep (NPs 1.1)   Yes, I perceive that that (shaped at the unit at the bedside) is more accessible and that is not my opinion, that is what the care team says. Yes, because the step to the physician…we have to take in mind that they are the care team; they see the physician as a status symbol (PA 5.5)	Contribution to quality of health care	Added value	Impact despite variation
	Provision of patient‐centered care
	Support of the care team
I expect from the future that it (skill mix change) will and has to be introduced more, because if I look at my 35 year career, what my tasks were as physician, I intervened in everything, because there was no one, and I arranged everything. I even knew it when glasses were lost (ECPs 3.1)	Negative side of monitoring role	Changing role of the ECPs
	Positive side of monitoring role

ECP = elderly care physician; NPs = nurse practitioner; PA = physician assistant; RNs = registered nurse.