Seale et al. (2006) have provided a much-needed comparative analysis of the different treatment advice given by general practitioners and nurse practitioners in their consultations with primary healthcare patients, which builds on their other recently published work regarding the nurse practitioner consultation (Seale et al. 2005). Their findings, namely that nurse practitioners conduct longer consultations than doctors, with increased use of talk by both patient and nurse practitioners alike, has resonance with previous consultation research regarding variant communication styles amongst doctors and nurses (Collins 2005).
In relation to the use of talk by clinicians and patients, Mishler (1984, p. 14) in his landmark study of medical consultations noted that patients accentuated the ‘voice of the lifeworld’, reflecting the subjectivities of everyday life while, in response, doctors tended to emphasize the ‘voice of medicine’ as seen in their use of objective scientific analyses in consultations. Mishler (1984) contended that this disparity of focus between doctors and patients in consultations results in ineffective medical care, as patients feel that their concerns are not being met. This has a subsequent detrimental effect on patient satisfaction, which in turn adversely affects patients’ adherence with suggested medical treatments.
In contrast, Johnson (1993) has noted that nurse practitioners, when conducting consultations, acknowledge the voice of the lifeworld as presented by patients, and respond appropriately by attention not only to medical matters, but also to incorporation of patients’ everyday life experiences. My own more recent research (Barratt 2005), a qualitative case study of communication in the nurse practitioner consultation, supports Johnson's (1993) earlier research. This case study demonstrated that in the consultations studied, nurse practitioners use the subjectivity of everyday life issues in conjunction with the objectivity of medicine as a successful consultation communication strategy, which helps maximize the patient-centred outcomes of their consultations. This finding concurs with Seale et al.’s (2006) analysis of nurse practitioner communication strategies. As such, this role hybridity allowed the nurse practitioners in both my own study (Barratt 2005) and that of Seale et al. (2006) to combine openness to patients’ agendas with the clinical decision-making that is evident in general practitioner consultations.
On a point of critique it must be noted that Seale et al.’s (2006) analysis is based on data collected in 1998, and that in the intervening 8 years there have been two significant policy developments related to advanced nursing practice, one being extended nurse prescribing and the other being prospective regulation of the title ‘advanced nurse practitioner’ (Nursing and Midwifery Council 2004). In light of these policy changes it cannot be assumed that the same practice conditions exist now for nurse practitioners as was the case in 1998. Given the significance of these new prescribing and regulatory policies for advanced nursing practice in the United Kingdom it is incorrect for Seale et al. (2006, p. 540) to state, regarding nurse practitioners, that ‘there have been no formal changes to their roles and responsibilities that might have affected the conditions of their practice significantly’ as their study data were collected in 1998. On the contrary, it must be envisaged that the twin achievements of prescribing freedom and regulatory recognition of nurse practitioners will have far reaching consequences for consultations conducted by nurse practitioners, both now and in the future.
In response to this criticism, what is urgently needed from researchers in nursing and the social sciences is recognition that nurse practitioners in primary health care are undertaking many of the roles previously only undertaken by general practitioners. Once this role change has been recognized by healthcare researchers, appropriate research strategies must be devised to ensure that we have an increased understanding of contemporary practice in nurse practitioner consultations and its resultant implications for patient satisfaction and outcomes.
In my role as a clinical academic nurse practitioner, with an interest in nurse practitioner consultation communication, I have recently been awarded a novice researcher bursary to conduct video-recorded analyses of the nurse practitioner consultation. This research is being initiated because, although nurse practitioners are increasingly undertaking patient consultations in primary health care, there has been a minimal correspondent rise in research on the process and outcomes of nurse practitioner consultations. In my proposed research study I seek to redress this imbalance by investigating video-recording of nurse practitioner consultations as a practical method for analysis of communication in these consultations. It is hoped that this advanced nursing practice study will provide a stimulus for researchers, both within nursing and social science, to explore in more detail the consultation process occurring between nurse practitioners and patients by using observational techniques. Techniques such as video-recording, which are routinely used in research into general practitioner consultations, are equally suitable for research data capture in nurse practitioner consultations. This type of exploration may provide valuable insights into the unique nature of the nurse practitioner consultation which, in turn, may improve the consultation practices of advanced nurse practitioners.