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An exploration of the role of substance misuse nurses in Scotland

Chapter 3: Characteristics of nurses and services

The questionnaire response rate was 79% (192/244).

Respondent characteristics

Table 3 shows that 65% of respondents were female (n=122). The average age of respondents was 39.5 years; range 24-60 years.

4/192 incomplete
² 7/192 incomplete

Table 4 details the grade and qualifications of responding nurses. Seventy per cent of nurses were Grade G or above.

respondents detailed all nursing qualifications held

In the questionnaire nurses were asked, to specify their job title. A wide range of self-reported job titles was identified (over 18 different titles), including Charge Nurse (16%), Community Psychiatric Nurse (12%) and Staff Nurse (14%). Few of these reflected the specialty of this area of work. The full list is displayed in Appendix 4 ( table A1).

Just over half the respondents (56%) worked exclusively with drug misusers. The average number of years working with drug misusers was 6.6 years (range four months to 20 years). Most respondents worked full-time (85%).

Training

No formal training (defined as university certificate or diploma) in substance misuse had been undertaken by 59% of nurses. However, induction training, i.e. in house training at the start of employment, had been received by 62% of respondents prior to receiving their own patient list. Shadowing a member of staff was considered very beneficial by the greatest proportion of those that had received it during induction. The majority of those who had received induction training found it beneficial. Ninety-one per cent of respondents noted that their current job enabled on-going training and 41% reported that specific time was allocated for training. However, 12 nurses noted they were unable to use this time for training as a result of resource constraints and workloads.

Service characteristics

Location of services

From questionnaire data nurses were employed in a range of settings including Substance Misuse Service/Drug Problems Service (48%), Drug and Alcohol Services (30%) and Residential Detoxification (3%). Almost all services were solely or jointly funded by the local area Health Board (98%). The services provided by employing organisations included counselling, assessment, methadone maintenance prescribing ( see Appendix 4 table A2). One hundred and seven nurses reported working with General Practice (62%), of these 66 worked for more than five practices.

Over half the respondents (58%) felt that the locally-provided services did not meet the needs of drug misusers in their area. When asked, in the questionnaire to consider how services could be improved more than half of respondent gave suggestions which included: issues of training, numbers of staff, accommodation, inpatient provision and 24-hour.

The health board location of services is displayed in Appendix 4 ( table A3).

Caseloads and consultation setting and timing

Caseloads

From questionnaire data the median caseload was 38 (range 2 to 220, the latter being from a needle exchange nurse). This was not influenced by grade. Nurses working only with drug misusers had significantly higher caseloads (p<0.01); there was no difference in median caseload by gender, age, location or years working with drug misusers. Nurses were asked in the questionnaire, how many clients they saw a week. The median number of patients/clients seen per week was 25 (IQR 17, 35) but 15 individuals saw over 60 clients a week. When asked about their 'ideal' 69% of nurses reported they would like to have fewer patients/clients.

Frequency of contact

From questionnaire data the frequency of patient contact varied from daily to once a month. Nurses reported that this contact depended on the service provided, such as residential care, and patient needs. Over 40% of nurses saw clients at least once a week. Some 41% of nurses spent over 67% of their time in direct patient care. Most time was spent in consultation with drug misusing clients, the least time was spent on management duties, attending courses and visiting drug misusers at home. There was no difference in proportion of time spent in direct/indirect activities by grade, gender or years working with drug misusers.

Consultation settings

Observation of consultations were conducted in three main locations, i.e. GP surgeries, drug services, or clients' homes. The majority of consultations took place in typical GP treatment rooms. Generally, these rooms were clinical and there was little or no information displayed. Some consultations, particularly those in drug services, were conducted in less clinical interview rooms. These rooms were brightly painted, had curtains, tables, lamps and pictures. Seating consisted of comfortable sofas or chairs. Most displayed an array of informative literature consisting of: health promotion and disease prevention, local services available to substance misusing clients, such as self-help groups, clinics offering advice on safe sex, harm reduction, HIV or AIDS, depression and anxiety. Other information relating to childcare, job clubs and back to work schemes was also displayed. The remaining consultations were conducted in clients' homes. From observation the consultation setting did not appear to affect the process of consultation. However, home consultations may have been beneficial to clients reducing the need for childcare and excess travelling.

Length of consultations

From questionnaire data the average reported length of consultation was 38 minutes (range five to 120 minutes). The length of the consultation did not appear to be related to the number of hours worked. Three quarters of nurses felt that the length of consultation was adequate, although some noted that this was insufficient to enable an in-depth or holistic consultation. Nurses with a caseload of over 50 clients were significantly more likely to spend less than 30 minutes with each client (p<0.001).

Observed clinic consultations (N=15) were scheduled for 30 minutes. However, four exceeded this time by approximately 10 to 15 minutes and a further three lasted between 60 and 90 minutes. The main reason for the latter was that clients appeared anxious or distressed and more time was required to explore issues. Home visits tended to last for 40 to 60 minutes, but again some (n=3) lasted longer due to clients' anxiety and distress. Most consultations started on time or within 10 minutes of scheduled time. Unfortunately some clients were left waiting longer than this, sometimes up to 15 minutes and on one occasion 30 minutes. The reason for these delays were sometimes due to a prolonged consultation with another client, but generally it was due to the failure of reception staff to inform nurses that their client had arrived.

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