Seeing patients first: creating an opportunity for practice nurse care?

Abstract

INTRODUCTION: Practice nurses see patients in both a planned (i.e. scheduled appointment) and an unplanned (i.e. opportunistic) manner. This study aimed to investigate how often and why New Zealand practice nurses see patients prior to the general practitioner and whether they organise their care to support unplanned, opportunistic activity. METHOD: National postal survey from a random sample of 500 general practices, requesting a response from one nurse per practice. Semi-structured telephone interviews with a purposeful sample of respondents. FINDINGS: Responses came from 225 nurses (51% of practices confirmed to be eligible). Nearly all (92%) said their work role was the same as that of others in their practice. Only 13% of nurses routinely saw patients prior to the doctor, while 24% would choose to do so it they could, and 65% thought it important. Positive and negative aspects of seeing patients first are presented. Constraints included time, their role assisting practice workflow and perceptions of patient expectations. Few organised their work to create opportunities for lifestyle interventions. CONCLUSION: The current working environment of practice nurses in New Zealand does not readily support them routinely seeing patients before the general practitioner. We suggest this is a lost opportunity for patient-centred preventive care. KEYWORDS: Practice nursing roles; opportunistic interventions; work organisation; primary health care; chronic conditions