Establishing a definition for a nurse-led clinic: structure, process, and outcome

This paper reports a study to define a nurse-led clinic by exploring the domains of structure, process and outcome. Nurse clinics have been introduced as a measure to support intermediate care after the acute phase of disease. Previous studies have been mainly descriptive, or have only addressed a particular aspect of clinic service. This exploratory study was conducted in two phases. In the first phase, nurses from 34 clinics were interviewed. In the second phase, 162 clinic sessions were observed, and 162 patients and 16 physicians were interviewed. The data were collected in 2001-2003. The nurses who ran the clinics were very experienced, and resources were available to support their work. Over 80% of their work was independent or interdependent, involving skills such as adjusting medications, and initiating therapies and diagnostic tests according to protocols. The principal interventions were assessments and evaluations, and health counselling. The nurses rated 'management of symptoms', 'prevention of complications', and 'client satisfaction' as the top three key indicators of their success. All patients studied showed improvement after the nurse clinic consultation, but the best rates were found in wound and continence clinics. Satisfaction scores for both nurses and clients were high. Physicians valued their partnership in care with the nurses, but were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. A nurse clinic is an effective alternative model of ambulatory healthcare delivery that uses a holistic framework.