Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres

Over the last decade, Swedish health care has focused on improving the management of sick-listing issues. At primary healthcare centres, sick listing is mainly dealt with by the patient's physician but when patients have requests related to sick listing and contact the telephone advisory service, nurses will be involved. The aim of this study was to describe nurses' experiences of managing sick-listing issues in telephone advisory services in a primary healthcare setting.

The study was a qualitative focus group study. Data collection was conducted in three focus group conversations in a county in central Sweden in 2009. The conversations were recorded, transcribed and analysed using qualitative content analysis. The study included fourteen nurses, purposively sampled as having current experience of telephone advisory services at primary healthcare centres.

The management of sick-listing issues was described by the nurses as Nurses Actions that were affected by Enabling conditions and Obstructing conditions. The Nurses' Actions included making an assessment for appropriate action, making an appointment and/or giving information and guidance to the patient and/or monitoring patient's rights. Enabling conditions included documentation, routines, supportive cooperation and training in insurance medicine. The obstructing conditions were related to patients' expectations, cooperation with other professionals, lack of training and the nurses' professional role.

The nurses experienced stress and difficulties related to being gatekeepers and related to the act of balancing different demands from patients, co-workers and the organisation. This in combination with the lack of training caused the nurses to state that they did not want responsibility for managing sick-listing issues. Sufficient documentation, education, routines, support of and discussions with other professionals at the primary healthcare centre could be ways of improving nurses' and other professionals' management of sick-listing issues.