The rapid introduction of remote consultations during the height of the pandemic meant some nurses in general practice felt their relationship with patients had become ‘more transactional than therapeutic’ and that they were ‘losing the essence of nursing’, a new study has shown.
However, nurses also suggested that remote appointments could help broaden access for patients and address staffing gaps during the Covid-19 crisis.
These were the findings of interviews and focus groups with 40 nurses working across general practice in England, carried out by the University of York, to explore the experiences of remote and technology-mediated working during the pandemic.
The paper suggested general practice nurses continued to deliver ‘a significant proportion’ of patient care in-person but that remote care could also meet patients’ needs, especially where rapport was built.
Despite this, some nurses had strong concerns that remote working had seen their patient reviews become ‘more of a fragmented “tick box” process than a comprehensive assessment’ and that ‘aspects of reviews were being missed or substituted’, the study warned.
In addition, some nurses felt that care had ‘become more transactional than therapeutic’ and that there were ‘potential safety risks’ with remote consultations used during the pandemic.
Nurses reported feeling ‘isolated’ when conducting remote consultations and that they ‘preferred consulting in-person as they missed in-person contact’.
Remote and technology-mediated working was also found to increase workload and, in some cases, nurses felt pressure to work from home to catch up with workload.
Concerns were also raised around the ‘lack of involvement of nurses’ in changes made around consultation delivery during the pandemic.
A ‘hierarchy of clinician priority’ also meant that ‘opportunities for general practice nurses and healthcare assistants to conduct video consultations, or to work from home, were fewer than for their GP and [advanced nurse practitioner] counterparts’, the study said.
Nurses also warned the ‘rapid introduction’ of remote working meant that not all technology was ‘fit for purpose’ and that implementation was ‘ad hoc’, leading to concerns about the risks associated with this way of working.
‘For some, remote and technology-mediated consultations, and the speed at which they had been implemented without due consideration, had negatively impacted on the patient–nurse relationship,’ the study noted.
One nurse said: ‘I’m quite angry as a patient and a nurse about how we weren’t consulted in general practice and the art of the consultation and those key core consultations skills I feel are being lost.
‘Now I may be a dinosaur and I’m not against technology, but I do feel that we haven’t got the balance right and I think we’re losing the essence of nursing care.’
On the other hand, some participants reported that remote working enabled practices to ‘address gaps in clinical staffing in novel ways and provided the means of addressing lack of appropriately qualified and experienced nurses’.
For example, some practices were able to counter a shortage of nurses in one geographical area by using nurses in another area to deliver care through remote consultations.
‘Participants skilled in managing a specific long-term condition worked remotely (either from home or from a practice in their own locality) to deliver care to patients in another locality,’ the paper said.
‘This was seen as one way in which technology facilitated effective ways of working.’
In addition, some nurses felt that remote care could be ‘quite effective’ if a rapport was established.
Participants also felt that technology could ‘help redress power imbalances’ between patients and practices.
‘Systems generally focus on patients being directed by the practice, whereas technology can aid patients to organise, and be proactive in, their care,’ the paper explained.
Co-author Dr Helen Anderson, from the University of York’s Department of Health Sciences, told Nursing in Practice that general practices should ‘reflect and build on what has been learned’ in relation to remote working to ‘ensure the future development of safe and effective nursing care’.
She highlighted that the approach taken by practices was often ‘blended’, with a mixture of in-person and remote care, noting that where this was beneficial, ‘it was expected to continue post-pandemic’.
Dr Anderson reiterated the concerns raised by nurses around patient safety risks, ‘losing the essence of nursing’ and the ‘little strategic input from nurses’ when changes were made.
Though she also recognised that remote care ‘helped solve some workforce issues by allowing specialised nurses from one locality to provide care remotely for patients in another locality where it was difficult to recruit GPNs’.
The research is the second paper, funded by the General Nursing Council for England Trust, released this week around the experiences of nurses working in general practice during the pandemic.
The first paper, published on Monday 30 October, found that a ‘top-down culture’ adopted by general practices during the Covid-19 crisis left nurses feeling undervalued, overlooked and unable to make valuable contributions to service design.