Task-shifting to advanced practice nurses in Flanders: A cross-sectional survey of physician's knowledge and attitudes

Healthcare systems face increasing pressures that drive interest in task-shifting to advanced practice nurses, a strategy supported by substantial evidence and reforms in many countries. Belgium recently formalized role expansion of advanced practice nurses through legislation that authorizes defined diagnostic, treatment, prescribing, and coordination activities within collaborative agreements.

This study investigates physicians' attitudes toward task-shifting from physicians to advanced practice nurses, identifies perceived barriers to such task-shifting, and maps current and potential areas in which task-shifting may occur. Additionally, the study explores physicians' views on the added value of collaborating with advanced practice nurses.

Online cross-sectional survey.

634 hospital-based physicians.

Quantitative and qualitative data were collected using a self-developed questionnaire between May and June 2025. The survey comprised six sections addressing respondents' background, collaboration with advanced practice nurses, knowledge of and attitudes toward the recent legislation, and views on potential task-shifting across eight regulated activities. Analyses were conducted in IBM SPSS Statistics (version 30). Descriptive statistics included frequencies and percentages for categorical and Likert-scale items. Binary logistic regression was performed to identify factors associated with positive attitudes toward task-shifting. Open-ended responses were analyzed using thematic analysis following Braun and Clarke's six-phase framework.

Among physicians, 18.8% reported being well informed about the new legislation, and 79.9% anticipated impacts on patient care. Overall, 56.9% rated the legislation positively, with less favorable views in dermatology and anaesthesiology. The regression model showed that medical domain and current collaboration with an advanced practice nurse were significantly associated with a positive attitude toward the legislation. The activities most frequently shifted to advanced practice nurses are patient anamnesis and the coordination of referrals to physicians within the same discipline and to other healthcare providers. In future, more than half of physicians (between 54.5% and 77.2%, depending on discipline) indicated a willingness to reallocate six of the eight surveyed activities. Most frequently reported barriers related to perceptions of physician-exclusive tasks, whereas financial concerns and doubts about advanced practice nurses' added value were least reported. Physicians perceived advanced practice nurses as contributing most to improved care quality, addressing unmet needs, and enhancing efficiency.

Most physicians find the new task-shifting legislation positive and believe advanced practice nurses can enhance care quality, address unmet needs, and improve efficiency. However, several barriers remain, highlighting the need for clearer information, defined roles, and robust frameworks for training, liability, and financial arrangements.

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