Of the 18 consumers who participated, there were 13 women (72.2%) and 5 men (27.8%). Participants were from across the adult lifespan. From the information disclosed, approximately half of the participants visited the practice nurse for issues related to a chronic health condition. Three participants (16.7%) had regularly attended the practice nurse for assistance with weight management. Four of the female participants (22.2%) described attending the practice with their children. The interview data revealed four themes. These themes and their sub-themes are described in Table .
Satisfaction with practice nurses: “they are first class”
Overall, participants were extremely happy with the care delivered by Practice Nurses and this is illustrated in the following excerpts from their transcripts: “I just think they’re [PNs] marvellous” (Melanie), “they are first class” (James), “She [PN] is the best thing that ever happened in my life” (Chrissy). This was characterised by two sub-themes; the way in which the PNs valued the consumers and listened to them and the development of ongoing rapport between consumers.
a) Being valued: “She listened to me and treated me like a person”
Several participants described how the practice nurses “listened to me and she treated me like a person” (Chrissy). Another participant conveyed “They didn't talk down to me because of my nationality which is good because some doctors take one look at me and then they talk so slow that I did start to get a bit angry” (Jacqui).
In contrast to their experiences with doctors, some participants expressed how they felt valued by Practice Nurses
I see the doctors as in a hurry and they get to the point of it and they make you feel - if it's something more serious - they make you feel like you've got to the cause of the problem. Whereas nurses, in my experience, just being that little bit more slower, calmer and they're a bit more personalised. They talk to you; they know your children, especially if you've been going somewhere for a long time like I have - I've just been very lucky (Natalie).
b) Developing relationships: You build up a rapport with them
Participants also described the benefits of developing an ongoing relationship with the practice nurse. “You build up a rapport with them and you feel confident with them” (Millicent). “They don’t sort of abandon you after the visit. You go back, they contact you” (Melanie).
The willingness of practice nurses to establish and build a rapport with the consumer and their family was highly valued. “They always remember who you are. They remember the children’s name which I always think’s great” (Natalie).
In contrast to the benefits of an ongoing relationship, some participants described the negative impact of not having an established relationship with the practice nurse;
I had somebody that filled in for someone. I’m really quite a private person. I really find it quite hard going to, you know - I … know that nurse and that’s who I go to. She gets to know me (Eliza).
Confidence with practice nurses: “she knows what she’s doing”
a) Appreciating practice nurses’ knowledge: “They explain things and that sort of puts me at ease”
Practice nurses were perceived by consumers as being knowledgeable and competent.
in the fact that her manner, her speaking and also her professionalism, the way she goes about her job, gives the customer, the patient, the confidence that, hey, she knows what she’s doing. I feel comfortable about it (James).
Consumers very much appreciated the detailed explanations given by Practice Nurses about their chronic conditions, the need for particular treatments or lifestyle changes.
They [Practice Nurses] explain things. They actually explain why they're doing what they're doing and that sort of thing so it puts me at ease. Even though I've had them [tests] all before but it's a different way of them explaining it all to me. I could understand it (Jacqui).
And often when I haven’t been able to take much pain relief, and they’re very good at explaining why.... I mean the doctors just haven’t got time have they? Well that’s how I feel anyhow. The doctor’s good too and often he’s not there so I would say they are very good at that sort of thing (Melanie).
Oh she's - how would you describe her - she's - she tells you what you need to know directly but indirectly. She's able to - she's tactful in how she tells you. There's some things you don't want to hear - sort of stuff - or you know but she just confirms it and that. I think I [unclear] want to know and I have learnt things that I need to be doing and that is all about, sometimes, you've got to pull your head in and do that (Violet).
b) Appropriate referral: “I know she’d get the doctor”
Underpinning this was the consumers’ confidence that “as soon as they see something’s not quite right, the doctor comes in” (Melanie). Whilst there was some indication that consumers wanted to retain the choice to see the GP if they chose to, the confidence that the PN would seek the advice of the GP was seen as comforting.
I would probably go to the doctor first if I could get in, which is a little bit of an issue up at this clinic at the moment, I’d probably go to the doctor, but having said that, if there was an issue I’d be perfectly happy to go to the practice nurse because I know she’d get the doctor (Melanie).
If I had a really serious incident, as you would call it, I would prefer a doctor to be available rather than a nurse.... I’m assuming, incorrectly or what, that a doctor would have a little bit more in-depth knowledge of determining or diagnosing what’s wrong than a nurse (James).
Participants spoke positively of the PN role in triaging when they needed medical attention.
She’s my first port of call and if I feel I have an emergency which is not a hospital emergency, then I will talk to a practice nurse (Ben).
The other time when I see my practice nurse is when I need something urgently. Now I’ve had occasion when I’ve had diarrhoea, that type of thing, or when I’ve felt really crook and I speak first of all to a practice nurse who then decides whether, well, usually I have to admit, usually decides then I’ll see a doctor (Ben).
Confusion around the practice nurse role: “when you say a practice nurse, I’m a little bit unsure what you mean”
For a couple of participants it was unclear who was a PN within their practice or what a PN is. “Well even the nurse that gave me the injection, …she was wonderful and she, I suppose she’s a practice nurse too really isn’t she” (Miriam). In referring to pathology blood collectors one participant commented. “Whether you would call those practice nurses or not I don’t know. (Ben)”.
A few participants described how the role of the PN had changed. “I think years ago they were just there. They came in when you were with the doctor and stood while you had a smear or whatever, but now they’re far more up front with what they do” (Melanie). Melanie went on to explain “I’m lucky I’ve been round the health system for yonks, and I wonder like sometimes if people ring up and make an appointment and there’s no appointments, do they understand that the practice nurses are available. Maybe they could be a little bit more prominent”.
Several participants did indeed express a lack of clarity about the PN role and the scope of their practice.
That’s where it’s quite grey to me because I don’t think it’s ever been made clear all the things that you could use the nurse for. So my usual port of call is usually the GP. It’s just been like the vaccinations and smear tests that I’ve ended up seeing the nurse instead (Sharon).
When you say a practice nurse, I’m a little bit unsure what you mean because, you see, now there is a nurse there that does nurse-type things for the doctor, you know, like bandages and looking after your wound, stuff like that…Then there’s the nurse … went through your notes, checked on your medication and make sure you’re doing it right (Barry).
Participants tended to base their perception of the PNs scope of practice around their experience of nursing services. “Yeah, definitely the vaccinations and smear tests I go to the nurse. There’s been a few things. Like my daughter sprained her ankle really bad a year ago. I ended up seeing the GP. I mean, if I could have gone to the nurse I would have done that if I’d known I could (Sharon)”.
Once participants had gained an appreciation of the practice nurse and their role they indicated that they returned to the nurse. “I’ve probably only really started to see them in the last two to three years because up until then I wasn’t really aware that they were there and available to me (Sharon)”.
A key PN role identified by consumers was that of substitution for the GP in simple tasks. Having the PN take on these tasks was seen as time saving for GPs, particularly in a context of workforce shortage. “There are things, those superficial things that it’s much better to go to a practice nurse because it’s not wasting his time” (Melanie).
I’m very happy for them to stitch me up or tape up whatever’s happening any of those sorts of things – anybody who’s trained can do those sorts of jobs. I’m not saying the jobs are too easy, but a nurse can strap up a sprained wrist with as much skill as a doctor can (Michelle).
Appreciation of Practice Nurse accessibility
a) Being readily available: "I don't have to wait around"
A common complaint among participants was the difficulty that they encountered in making appointments and receiving treatment from a GP.
Once upon a time we could just make an appointment there and then get in today and see our doctor. It’s not like that anymore. You’ve got to make appointment perhaps for – make an appointment today for next week perhaps or even, you know, two or three days’ time when they’re on duty (Miriam).
Contrary to this experience of having to wait for extended periods for a GP appointment, Practice Nurses were seen as being readily available for consultations. Consumers valued not having to wait to see the Practice Nurses and appreciated them being contactable by telephone if support or advice is required.
I’m waiting for this hip replacement, they’ve been marvellous. When things have gone wrong, I’ve been able to see them straight away (Melanie).
I don’t normally – I certainly don’t to have to wait round very much to get to see a practice nurse and if I do, I simply leave a message and they’ll call me back, probably within a half hour, but certainly within the hour. It is what I’d call virtually immediate access (Ben).
It’s usually pretty good. It can be a lot quicker than waiting to see the doctor. You can guarantee if you want to see a nurse you can get in today (Sharon).
b) Affordable care: “So easy on my funds”
Accessibility of practice nurses was also enhanced due to the lower financial cost for consumers. This was particularly important for consumers who were low income earners and pensioners.
Yeah, because - and not only that - I suppose it actually - it takes the pressure of the doctors for, you know, some of the things. Not only that, it makes it a lot easier for me. It doesn’t become so costly because, you know, some of the things I see the practice nurse for it doesn’t sort of tie up the doctor really, you know, makes it so easy on my funds too (Bill).
We pay $20 when we go to see the care nurse but we pay about $39.90, I think it is, to see the doctor. That for us really is very helpful (Abbey).
Participants also reflected on the value for money in seeing the GP rather than the PN. “Sometimes I think god, that was a useless visit. I paid $51 for nothing. I could have got that off [the PN]” (Violet).