Practice Nurses and venepuncture: a multipractice study

The objective of this work was to investigate the frequency and nature of other issues being introduced by patients when seeing the practice nurse for venepuncture, and the ability of the practice nurse to respond without referral to another team member. A survey was designed for of all consultations for venepuncture with 18 practice nurses over a two week period. These were set in general practices in Wessex. Rural, semi–rural and urban practices were represented. The main outcome measures were: the proportion of venepuncture consultations which included an associated activity; the frequency with which patients presented a new problem; and the ability of the nurse to deal with the patient's problem. Results show that 85% of venepuncture consultations included associated activities and that 36% of patients presented a new problem which the nurse felt able to deal with in 95% of instances. It is concluded that associated activities frequently accompany the task of venepuncture when performed by a practice nurse rather than a phlebotomist. The ‘added value’ a nurse brings to this task include monitoring patients with chronic conditions, clarification of what the GP has said in a previous consultation, and dealing with newly presented health problems. Decisions about delegation of tasks within the primary health care team should consider not only the complexity of the task and the savings accrued, but also the quality of care and the ‘knock on’ effects of change on consultation rates.