Trust and decision-making: How nurses in Australian general practice negotiate role limitations.
OBJECTIVE
To explore the importance of role recognition and relationships between the opportunities for decision-making, social support, and skill development, in a sample of nurses working in general practice in New South Wales, Australia.


BACKGROUND
Understanding how nurses make decisions about patients and their care in general practice will benefit organisations and public policy. This understanding is important as the role changes and opportunities for further role development emerge.


METHODS
A sequential mixed methods design was used. Study 1 utilised the internationally validated Job Content Questionnaire to collect data about decision making, social support, skill development, and identity derived from the role. In 2008 a purposive sample of nurses working in general practice (n = 160) completed and submitted an online Job Content Questionnaire. Study 2 used a set of open-ended questions informed by Study 1 to guide semi-structured interviews. In 2010 fifteen interviews were undertaken with nurses in general practice. Demographic characteristics of both samples were compared, and the findings of both studies were integrated.


RESULTS
The integration of findings of Study 1 and 2 suggests that nurses defined their expertise as being able to identify patient need and communicate this to the general practitioner, the ability to do so led to the development of trusting relationships. Trusting relationships led to greater support from the general practitioner and this support allowed the nurse greater freedom to make decisions about patient care.


CONCLUSIONS
Nurses gained influence in clinical decision-making by building trusting relationships with patients and medical colleagues. They actively collaborated in and made decisions about patient care. These results suggest that there is a need to consider how nursing can more effectively contribute to care in general practice settings.
Eamon Thomas
ET
Merrick
Margaret
M
Fry
Christine
C
Duffield
Helen
H
Stasa
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D009517:New South Wales; D024802:Nurse's Role / Q000523:psychology; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D036301:Qualitative Research; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035502:Trust