A sustainable healthcare system requires moving assistance from the hospitals to patients’ homes. This new model of care requires the home care organizations to review the role of home care professionals. This change of work practice is particularly relevant for nurses that are a key figures in the process of value co-creation. To support healthcare providers and policy-makers in guiding this change, this research aims at studying the mechanism of task shifting in home care nurses using an ecosystem perspective. Given the exploratory aim of the study, a multiple-case study methodology was chosen by selecting four home care providers in Italy. Results revealed that the role of the nurses is evolving through all three typologies of task shifting: enhancement, innovation and delegation of activities from general practitioners to healthcare assistances. The types of activities that were shifted among professionals, patients and their caregivers were interactive and administrative activities mainly, but also care and educational tasks. The root causes that led to the shift of tasks during home care assistance were organized into four categories: organizational, patients’ needs, environmental and individual forces. Finally, this research made a first attempt to study the influence of task shifting on the other actors of the service ecosystem. Results revealed that the activities that nurses performed in addition to their routine activities influenced the micro, meso and macro levels.