Medical receptionists in general practice: Who needs a nurse?

Patterson, Elizabeth; Mar, C. Del; Najman, Jake M.

doi:10.1046/j.1440-172x.2000.00213.x

Cited by 25 publications

(6 citation statements)

References 18 publications

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“…This paper also resonates with wider literature demonstrating the importance of intermediaries such as administrative staff in handling and processing decisions in the context of organisational routines [51–53]. Across all of the study practices, receptionists played a pivotal role in results handling decision-making by drawing on context-specific, tacit knowledge that they had developed over time, with this also impacting on patient outcomes.…”

Section: Discussionsupporting

confidence: 71%

The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice

et al. 2017

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BackgroundThe handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is achieved in everyday practice. This paper ethnographically examines the role of informal dimensions of test results handling routines in the achievement of safety in UK general practice and how these findings can best be developed for wider application by policymakers and practitioners.MethodsNon-participant observation was conducted of high-volume organisational routines across eight UK general practices with diverse organisational characteristics. Sixty-two semi-structured interviews were also conducted with the key practice staff alongside the analysis of relevant documents.ResultsWhile formal results handling routines were described similarly across the eight study practices, the everyday structure of how the routine should be enacted in practice was informally understood. Results handling safety took a range of local forms depending on how different aspects of safety were prioritised, with practices varying in terms of how they balanced thoroughness (i.e. ensuring the high-quality management of results by the most appropriate clinician) and efficiency (i.e. timely management of results) depending on a range of factors (e.g. practice history, team composition). Each approach adopted created its own potential risks, with demands for thoroughness reducing productivity and demands for efficiency reducing handling quality. Irrespective of the practice-level approach adopted, staff also regularly varied what they did for individual patients depending on the specific context (e.g. type of result, patient circumstances).ConclusionsGeneral practices variably prioritised a legitimate range of results handling safety processes and outcomes, each with differing strengths and trade-offs. Future safety improvement interventions should focus on how to maximise practice-level knowledge and understanding of the range of context-specific approaches available and the safeties and risks inherent in each within the context of wider complex system conditions and interactions. This in turn has the potential to inform new kinds of proactive, contextually appropriate approaches to intervention development and implementation focusing on the enhanced deliberation of the safety of existing high-volume routines.

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Section: Discussionsupporting

confidence: 71%

The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice

et al. 2017

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“…In the early period, Patterson [16] undertook a case study of the role of nurses employed within a single region of general practices. This study described differences in perception of the nature of the nursing role in general practice between general practitioners and nurses.…”

Section: Introductionmentioning

confidence: 99%

“…This study described differences in perception of the nature of the nursing role in general practice between general practitioners and nurses. Through this work, Patterson [16] identified a lack of understanding of the boundaries of the nurses scope of practice. Several years later the Royal Australian College of General Practitioners and the Royal College of Nursing, Australia sought to investigate the roles of nurses working in general practice across Australia [17,18].…”

Section: Introductionmentioning

confidence: 99%

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

et al. 2014

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BackgroundNursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time.MethodsIn the nascence of the expansion of the role of nurses in Australian general practice (2003–2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009–2010 and comparative analysis of the datasets undertaken to explore workforce changes over time.ResultsTwo hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses’ role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses’ role in general practice was slightly decreased over time.ConclusionsThis study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce.

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“…As well as administration, they engage in clinical activities for which they are ORIGINAL SCIENTIFIC PAPER ORIGINAL RESEARCH: WORkFORCE untrained, such as triage. 9,10 It has been questioned whether receptionists sometimes act as de facto nurses, lowering costs to the practice. This function has been identified as a potential legal risk to practices 9 as well as to receptionists.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 It has been questioned whether receptionists sometimes act as de facto nurses, lowering costs to the practice. This function has been identified as a potential legal risk to practices 9 as well as to receptionists. 11 Receptionists may have considerable informal power to influence patients' access to clinical care 6 yet it is unclear how much power receptionists really have in general practices.…”

Section: Introductionmentioning

confidence: 99%

The care work of general practice receptionists

2016

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IntroductIon: The care work of general practice receptionists has received limited research attention, despite receptionists position at the beginning of patients' journeys in many health care systems. We examine receptionists' perceptions of their work and the opportunities and constraints they experience in caring for patients while providing administrative support to practices.Methods: Data were collected in focus group interviews with 32 receptionists from urban and rural general practices in the Auckland and Northland regions of New Zealand. We employed tools from inductive thematic analysis and Straussian grounded theory in interpreting the data. FIndIngs:We found that the way receptionists identified with a caring role strongly challenged the pejorative view of them in public discourse. Receptionists provide care in two key ways: for the practice and for patients. The juggling they do between the demands of the practice and of patients creates considerable work tensions that are often invisible to other staff members.conclusIon: Receptionists have a critical role as the first step in the patient care pathway, bridging health care system and community. For general practice to be patient-centred and improve accessibility for the most vulnerable, the care work of receptionists must be considered core.

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Medical receptionists in general practice: Who needs a nurse?

Cited by 25 publications

References 18 publications

The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice

The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

The care work of general practice receptionists

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