Results

Sixty four letters, summaries, and questionnaires were posted to patients. After four weeks 35 replies (55%) had been returned. No second mailing was possible because the replies were anonymous. The results are in table 1; the scores for each selection were added together and the value split if a respondent had ticked two or three answers (that is 0.5 and 0.3).

Overall patients preferred to see a specialist nurse in five areas. On one occasion the nurse and dietitian were equal. Scenarios where nurses were significantly preferred to doctors related to diet, housing and social issues, obtaining leaflets, and who would spend the most time discussing patient focused problems.

Patients preferred to see a consultant on three occasions and this was significantly so when it concerned problems with IBD and for an annual review.

The question that dealt with a discharge showed that the specialist nurse and consultant were comparable but when comparing nurses and all grades of doctor the result is significant (z=2.8, p<0.005).

The social worker was favoured in the scenario about housing and social issues but only by one vote over the specialist nurse, with the specialist nurse and social worker scoring 13.5 and 14.5 respectively, which is not significant.

Discussion

Clinical nurse specialists are becoming more popular. There is much debate as to whether they are simply a cheaper option to doctors and a way by which to reduce junior doctors hours and work load or whether they enhance nurses' work and benefit patients.2This study was conducted to see who patients would prefer to see in various clinical scenarios. At present there is no clinical nurse specialist/nurse practitioner for IBD available at the hospital in which the study was conducted so the patients have not had any direct experience of such a role.

Patients have a significant preference for specialist nurses over the consultant in the following areas: diet, housing and social problems, and asking about patient education leaflets. They also felt nurses would spend most time talking to them, and to their families. For the questions on diet and the social/housing two other professionals scored highly, namely the dietitian and the social worker, but the specialist nurse still did better than the consultant.

Consultants were significantly more popular than specialist nurses when it came to clinical problems about IBD and for annual review. However patients felt specialist nurses have more time and want to see them for other aspects of their care. This could be either because they do not want to bother consultants with what they feel might be petty things or because they believe consultants are too busy and have only limited time in outpatients.

A survey be McGee et al looked at the expectations of senior personnel in NHS trusts with regard to specialist and advanced nursing roles.3 The top three activities identified were teaching (patients, staff, and carers), 207/230 (90%); clinical practice (direct care, specialised work, limited prescribing, diagnosing and treating in specific care programmes), 174/230 (76%); and consultant/advisor/leader to hospital/colleagues, 155/230 (67%).

There were no gastroenterology specialist nurses who responded to McGee's questionnaire, but this study shows there is a need by patients with chronic gastroenterological conditions for a designated gastroenterological nurse. Patients feel specialist nurses have more time to perform a teaching role. By teaching other members of staff about their condition and the needs of patients the quality of care may be increased in an area that patients feel is lacking (A Read, JF Mayberry; focus group in inflammatory bowel disease, unpublished).

Conclusion

Specialist nurses need to develop their role so that they are not seen simply as cheaper options but can provide a much needed service for patients with chronic diseases who want someone they can talk to and spend some time with them. This study did show that specialist nurses scored much higher than junior doctors throughout each scenario. Patients want to have some continuity in their care and they are aware that junior doctors are on rotation so will probably not see them at their next appointment. When patients have to repeat their history at each visit they feel the consultation is not beneficial. By seeing the same personnel each time, be it a consultant or a specialist nurse, the patient feels they are known to them and this helps to build up their trust.

How should hospitals develop this service? Should there be a specialist nurse for all gastroenterological patients or just for patients with chronic conditions, for example IBD? Should the specialist nurse be hospital based or also work in the community?

However, we must not forget that McSharry makes the point that specialist nurses have developed “within areas of nursing practice where the medical profession are least dominant, for example terminal or palliative care teams”.4 Does this mean gastroenterology is a medically dominated area and nurses will not be allowed to develop despite the wishes of the patients?