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, o n the practice nurse (PN), the skills and knowledge of the rheumatolog y nurse practitioner (RNP), hitherto, exclusively, a member of the hos pital team. A trained and experienced RNP paid a series of regular vis its to participating general practices in SE London. The subjects were 11 PNs and 30 patients with chronic rheumatic diseases. Interactive s essions 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 ca re of patients, and (2) educating patients about their disease and its treatment. Practice nurse and patient questionnaires were used to ass ess PN and patient knowledge before and after the instructional sessio ns. Only eight out of the 392 (2%) practices approached participated i n the project and, even with these: difficulties were encountered, ari sing from the PNs' workload and pattern of work, and the reluctance of the general practitioners to enter a new project in the present clima te of change in the NHS, unless clear and immediate financial advantag es were in prospect. Statistically significant results were obtained i n before/after comparisons of patient and nurse knowledge scores (P < 0.00001 and P = 0.001, respectively) following the RPN visits. The bas ic instructional format is sound and workable. A PN, if allocated prot ected time and appropriate patients, can acquire the knowledge and ski lls needed to manage patients with chronic rheumatic diseases in prima ry 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.