Practice nurses in general practice: a rapidly growing profession in The Netherlands.

Background: In 1999, nurse practitioners were introduced. The main objectives were to improve quality of care for chronic ill and to reduce workload of general practitioners. In ten years the number of practice nurses has grown tremendously. Meanwhile there are new tasks as a result of aging. Practice nurses will be needed in the expanding elderly care. The question is whether the number of practice nurses is sufficient and sufficiently trained for these tasks. Methods: Secondary analyses were performed on three data sources (NIVEL). Video-recordings were collected and communication skills were analyzed: 19 nurses and 181 patients. Performed tasks were analyzed by using data of LINH in 2008 and 2010. In 2008 data were retrieved from 54 GP practices and in 2010 from 76 practices. Tasks were analyzed using registration of consultations and diagnosed main complaints. From the registration of GP practices numbers and characteristics of practice nurses were derived. Additionally, interviews with teachers and online training information were analyzed. Results: GP registration indicated the growth of practice nurses in ten years. In 2001 only 6% of GP practices employed practice nurses and in 2011 in 75% of all practices. In total 1.867 FTE (fulltime equivalents) nurses are working with an average of 0.4 FTE per GP practice. Tasks of practice nurses are related to control consultations of patients with diabetes (38%), hypertension (21%) and asthma or COPD (9%), next to lifestyle advices. Practice nurses are highly trained at following guidelines and in applying a range of communication skills. Motivational interviewing was used less. These skills are aimed at changing behavior and life-style. Conclusions: As a result of the extension of tasks, an increase of trained practice nurses is needed, both in number and FTE per practice. The competencies for control tasks are sufficient, but completion of knowledge about elderly care and identifying multimorbidity also calls for a more generalist training. (aut. ref.