Patients’ perceptions of changing professional boundaries and the future of ‘nurse-led’ services

Abstract

Nurses are increasingly being employed instead of doctors in some areas of work. This article examines this phenomenon in relation to a 'nurse-led' Personal Medical Services Primary Care Act pilot scheme. As part of an evaluative project, we examined the way in which patients understood and constructed nursing roles in the context of their use of primary care services in a socially deprived area. Whilst professional roles are established to some extent as the result of negotiation between and within professions and with government policymakers, patients' perceptions also affect whether or not changes are accepted, and the extent to which new roles gain legitimacy. Our evaluation took the form of a case study with questionnaires, in-depth interviews and observations. This particular paper is based mainly on data obtained from interviews with patients who had experienced the nurse-led service. The results showed that some patients attributed high status to the nurse by emphasizing that the nurse leading the practice was highly qualified, and other patients reconstructed the role and thought of the nurse as a doctor. This latter interpretation was derived from the patients' descriptions of core activities such as diagnosis and treatment, and other factors such as an absence of uniform. However, the most important factor that affected whether or not patients accepted a 'nurse-led service' related to the way in which the service met their needs. This seemed to be more important than perceptions of professional identity. The nurse-led service continued to provide the social support and continuity of care that the patients valued, and which had been provided by their previous general practitioner. The provision of these aspects of care appeared to be more important than whether or not the service was nurse-led or doctor-led. It is important to consider patients' perceptions of policy innovation when establishing new services.

Citizens’ expectations and likely use of a NHS Walk‐in Centre: results of a survey and qualitative methods of research

“…People’s perceptions of a nurse‐led service may change when they have actually experienced this new form of health‐care. A recent study has shown that people living in a highly deprived area were most enthusiastic about their nurse‐led practice once they had experienced the service for a few months 26 …”

The Clients’ Perspective – Do military uniform and rank impact on the therapeutic relationship between military mental health clients and clinicians

“…Chapple et al [4] carried out a case study which was an attempt to evaluate clients' perceptions of changing professional boundaries in primary care services. The results showed that some patients credited the leading nurse as the most highly qualified and perceived the nurse to be a doctor.…”

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“…These initiatives regard primary care services as a broader public health resource besides a means of simply providing treatment to individuals. A recent evaluation study of a PMS nurse-led project in the deprived inner-city area of Salford (in northwest England) suggests that local people perceived the service as providing a stable source of social support in an area where other sources of "social capital" and longstanding social networks were being eroded (Chapple et al 2000). After May 1997, the Labour government greatly expanded area-based initiatives aimed at regenerating deprived communities.…”