The role of the rheumatology nurse practitioner in primary care: An experiment in the further education of the practice nurse

The aim of the project was to explore the possibility of conferring, on the practice nurse (PN), the skills and knowledge of the rheumatology nurse practitioner (RNP), hitherto, exclusively, a member of the hospital team. A trained and experienced RNP paid a series of regular visits to participating general practices in SE London. The subjects were 11 PNs and 30 patients with chronic rheumatic diseases. Interactive sessions involving the RNP, PN and patients were set up with a view to (1) instructing the PNs in the role of the RNP in the education and care of patients, and (2) educating patients about their disease and its treatment. Practice nurse and patient questionnaires were used to assess PN and patient knowledge before and after the instructional sessions. Only eight out of the 392 (2%) practices approached participated in the project and, even with these: difficulties were encountered, arising from the PNs' workload and pattern of work, and the reluctance of the general practitioners to enter a new project in the present climate of change in the NHS, unless clear and immediate financial advantages were in prospect. Statistically significant results were obtained in before/after comparisons of patient and nurse knowledge scores (P < 0.00001 and P = 0.001, respectively) following the RPN visits. The basic instructional format is sound and workable. A PN, if allocated protected time and appropriate patients, can acquire the knowledge and skills needed to manage patients with chronic rheumatic diseases in primary care. Both the instruments of measurement used can register changes over time, leading in a small number of patients (30) and PNs (11) to a statistically highly significant result.