Location of Repository

Emergency nurse practitioners and doctors consulting with patients in an emergency department : a comparison of communication skills and satisfaction

By Harbinder Sandhu, Jeremy Dale, Nigel Stallard, R. Crouch and E. Glucksman


Background: Emergency nurse practitioners (ENPs) play an increasingly important role in UK emergency departments (EDs), but there is limited evidence about how this affects patient care and outcome. A study was undertaken to compare the content of, and satisfaction with, consultations made with patients presenting with problems of low acuity to an ED.\ud \ud Methods: Patients presenting with "primary care" problems were allocated to senior house officers (SHOs, n = 10), specialist registrars/staff grades (n = 7), sessionally-employed general practitioners (GPs, n = 12) or ENPs (n = 6) randomly rostered to work in a consulting room that had a wall-mounted video camera. At the end of each consultation the doctor/ENP and the patient were asked to complete the Physician/Patient Satisfaction Questionnaire. A stratified sample of videotaped consultations (n = 296) was analysed in depth using the Roter Interaction Analysis System. The main outcome measures were length of consultation; numbers of utterances of doctor/ENP and patient talk related to building a relationship, data gathering, activating/partnering, and patient education/counselling; doctor/ENP and patient consultation satisfaction scores.\ud \ud Results: ENPs and GPs focused more on patient education and counselling about the medical condition or therapeutic regimen than did ED doctors. There were no significant differences in consultation length. ENPs had higher levels of overall self-satisfaction with their consultations than ED doctors. Patient satisfaction with how actively they participated in the consultation was significantly associated with the amount of talk relating to building a relationship and activating and partnering, and patient satisfaction with information giving in the consultation was significantly associated with the amount of talk relating to building a relationship.\ud \ud Conclusion: These findings suggest differences between ENP and ED doctor consultations which are associated with some aspects of patient satisfaction. In contrast to previous reports, consultation length was not greater for ENPs than for doctors. There is a need for further research to test the generalisability of these findings and their impact on clinical outcome

Topics: RT, RC
Publisher: BMJ Group
Year: 2009
OAI identifier: oai:wrap.warwick.ac.uk:903

Suggested articles



  1. (1992). A dynamic role that improves the service: combining triage and nurse practitioner roles in A&E. Prof Nurse
  2. (2000). An evaluation of the care of patients with minor injuries in emergency settings. Accid Emerg Nurs doi
  3. (1999). An evaluation of the nurse practitioner role in a major rural emergency department. doi
  4. (1999). Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial. Lancet doi
  5. Communication skills of nurses during interactions with simulated cancer patients. doi
  6. (1998). Doctor-patient communication and patient satisfaction: a review. Fam Pract doi
  7. (2004). Doctor-patient communication, Introduction to series. Can Fam Physician
  8. (2009). Doctors and nurses in emergency care: where are the boundaries now? Trauma 2004;6:211–6. doi
  9. (1993). Effect of emergency department information on patient satisfaction. Ann Emerg Med doi
  10. (1998). Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey. doi
  11. Emergency nurse-patient interaction behaviour.
  12. Evaluating emergency nurse practitioner services: a randomised controlled trial. doi
  13. (2001). Health. Reforming emergency care: first steps to a new approach. London: Department of Health,
  14. (2005). Measuring patient-cantered communication in patient-physician consultations: theoretical and practical issues. Soc Sci Med doi
  15. (1994). Nurse-patient communications. Accid Emerg Nurs doi
  16. (2004). Observation of nurse-patient interaction in oncology: review of assessment instruments. Patient Educ Couns doi
  17. (1976). On the methods and theory of reliability.
  18. (1999). Patient centred communication. Annu Rev Nurs Res
  19. Patient satisfaction with emergency nurse practitioners in A&E. doi
  20. (1993). Physician satisfaction with primary care office visits. Collaborative study group of the American Academy on Physician and Patient. Med Care doi
  21. (1996). Radiographic interpretation by nurse practitioners in a minor injuries unit. doi
  22. Satisfaction with the outpatient encounter: a comparison of patients’ and physicians’ views. doi
  23. (1990). The patient, the doctor and the emergency department: a cross-sectional study of patient-centeredness in doi
  24. (2001). The relationship between residents’ and attending physicians’ communication during primary care visits and illustrative use of the Roter Interaction Analysis System. Health Commun doi
  25. The Roter Method of Interaction Process Analysis. doi
  26. (2004). Therapeutic communication part 2: Strategies that can enhance the quality of the emergency care consultation. Accid Emerg Nurs doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.