Scottish GP Patient Experience Survey 2009/10, Volume 3: Findings from the Analysis of Patient Comments

6 Consultation with the Nurse

6.1 The comments within 'Nurse' formed the smallest thematic group within the framework, with 718 comments left by patients (2 per cent of all comments). Nurses working in GP practice setting will include: practice nurses, district and community nurses, midwives, health visitors as well as other specialist nurses. In the majority of comments, it was not clear which nurse the patient referred to. However, in some instances specific nursing roles were mentioned. The comments relating to nurses comprised a similar number of positive and negative ones.

6.2 The main findings relating to nurses in the national report showed that patients felt most positive about nurses listening to them (96 per cent of people agreed or strongly agreed that the nurse listened to them). The lowest related area related to whether the nurse had enough information to treat them (91 per cent of people agreed or strongly agreed that the nurse had all the information they needed to treat them).

6.3 Within the group of positive comments about nurses, the main themes to emerge were:

• overall manner and caring approach of nurses;
• nurses providing clear explanations of treatment and conditions;
• praise for specific groups of nurses.

6.4 Within the group of negative comments, the themes identified were:

• poor attitude (or similar) of nurses;
• lack of nursing staff in GP practice;
• some nurses lacking enough information/knowledge about condition;
• complaints of nurses thinking 'they know better' or disregarding the doctors' instructions/advice;
• lack of confidence in nurses skills, in procedures such as blood tests, smear tests, injections, etc;
• concerns about hygiene while procedures are being carried out.

6.5 Most of the positive comments tended to praise the overall manner and attitude of nurses. There were some comments which suggested that patients felt nurses were better at listening to them, or that they felt more comfortable talking to a nurse than a doctor.

"The doctor always listens to what I have to say but I feel more comfortable talking to the nurse about personal female issues. She always has time to talk to you even if you just contact her by telephone for some advice."

6.6 Several also said that nurses tended to be better at explaining things in language understandable to them.

"If I need advice a triage nurse phones me back. They remember your history and can prescribe certain medicines without me having to "waste" a doctor's appointment. I am always treated extremely professionally and spoken to about my diagnosis in a language I can understand!"

6.7 Some of the comments left by patients praised specific groups of nurses working with the GP practice.

6.8 While most of the comments praised the manner and approach of nursing staff, a reasonable number of negative comments were critical of the overall manner of some nurses.

"I feel I have to complain about my practice nurses. I have had a few bad experiences. Some have been rude, abrupt and seem to delight in belittling you. Patients' conversations can be heard outside. The nurses must know this yet they seem to delight in talking loud. They often question the doctor's instructions and requests, which in turn does not fill me with confidence. I've only ever gone to get a blood test which should have been straight forward."

6.9 The negative comments also suggested that some patients felt there were too few nurses and some of them were overworked. Other comments related to a perceived need for nurses to have better training for basic procedures such as taking blood.

6.10 A final concern highlighted in the comments related to hygiene during procedures.

"I have on several occasions been to the nurse for blood tests and have been surprised at the usual disregard for basic hygiene - From not washing hands prior to commencing the procedure to coughing/sneezing into her hand at the time of handling syringes, cotton wool, etc."

Summary

6.11 'Nurse' was the smallest group of comments, representing two per cent of all comments left by patients. There was a mix of negative and positive comments, although nurses were actually rated very positively in the survey statistical results. Particular praise related to the overall manner and caring approach of nurses as well as the ability of nurses to provide clear explanations around treatment and conditions. Like the comments about doctors, where patients raised concerns, these tended to contradict the positive comments. The main issues raised by patients included: attitude of some nurses; perception of not enough nursing staff at GP surgery; and perception that some nursing staff lacked enough knowledge about conditions.