The Practice Nurse : A Comparison of Canadian and British Patient Acceptance

IN BOTH CANADA and the United Kingdom, the attention of the medical profession has been focusing on the nurse as a solution to the increasing demands being made on first contact health services. Many feel that the registered nurse with some extra training is capable of taking on several of the family physician's tasks. Estimates of the amount of usual physician work load she can assume vary from 25 to 75 percent but, as yet, accurate measurement of this has not been documented. A report by the Royal College of General Practitioners (1968) has suggested that the accurate measurement of nurse contribution to family practice may not be possible in terms of reduced physician workload, but that the success of such innovation may best be evaluated by assessment of patient, doctor, and nurse attitudes. In Canada, Badgley and Cohen (1971)2 stated, "Little is known about the extent to which doctors, nurses and patients accept the medical assistant or nurse practitioner, or the circumstances under which change here can most effectively be introduced for all concerned". Two British general practitioners, Smith and O'Donovan (1970),3 described the work of the "new practice nurse" in their own practice in Tamworth, Staffs. As part of their study they assessed patient reaction to her services. A study into the potential and training of family practice nurses was conducted in Kingston, Ont., during 1971 and 19724 and the method of evaluating patient acceptance was modified to include questions asked in the Tamworth study. The results permit a comparison of patient attitudes on both sides of the Atlantic. There are fundamental differences between the two countries in the delivery of primary health care services and, not surprisingly, differences in patient attitudes to the physician. Some of these have been reported by Marsh and Sweeny (1971)5 in recounting their experiences during a practice exchange between Canada and the U.K. Patients from three family practices (one a partnership of two, the others solo practices) received care from