Nurse-physician collaboration and decision outcomes in transplant ambulatory care settings

This study examined the nature of nurse-physician collaborative practice as reflected in problems presented by transplant patients in telephone contacts with clinical nurse specialists (CNSs).

Exploratory descriptive study.

The sample consisted of 202 renal and renal-pancreas transplant recipients who telephoned nurses at the outpatient clinic of a tertiary care medical center.

Over a period of 6 weeks, using a data collection form, nurse specialists recorded the types and frequencies of problems described by transplant patients via telephone interaction and categorized the outcomes of decisions.

Of the 437 calls, averaging 2.16 calls per patient, problems were classified as general questions (46%), medication related (32%), and clinical signs and symptoms (22%) such as fever, rejection, colds, and urinary tract infections. Decision outcomes (n = 354) categorized as independent or collaborative for problem resolution were: CNS only (80%), MD only (11%), and collaborative (9%).

Resolution of 80% of patients' problems presented in telephone interactions shows that advanced practice nurses play a pivotal role in the delivery of care to outpatient transplant recipients. Independent decision making on the part of the nurse occurs within the context of ongoing collaboration and communication with physician colleagues.