Karin Bergman

Background: Internationally, interest in the expanding role of registered nurse–led consultations in primary care is increasing. This role requires effective communication to support triage and clinical decision-making. While physician‒patient communication has been extensively studied, research on registered nurse‒patient communication remains limited, particularly in primary care. Therefore, the aim of this scoping review was to map and describe how registered nurse–patient communication and decision-making in primary care consultations are characterised in the existing literature, based on observations of clinical practice. Methods: This scoping review included a systematic literature search conducted in March 2025 in the PubMed, CINAHL, Web of Science and Scopus databases. A total of 12,066 records were identified and screened. The review followed the methodological framework of Arksey and O’Malley and adhered to the PRISMA-ScR reporting guidelines. Results: A total of 16 studies were included. Registered nurse‒patient communication was observed using audio- and video-recorded observations and participant observations during telephone consultations ( n = 5), chronic disease management consultations ( n = 3), mental health consultations ( n = 1) and walk-in clinic consultations ( n = 7). Findings on communication and decision-making were organised into four themes related to the key characteristics of exploring patients’ concerns, observing and assessing patients’ health status, tailoring communication, and facilitating decision-making with patients. Conclusion: The findings indicate that registered nurses use various communication skills during different phases of consultations. However, comprehensive studies on registered nurse–patient communication and decision-making in primary care are lacking. This highlights the need for future in-depth and comprehensive studies on registered nurse–patient communication in primary care to inform both clinical practices and nursing education. Trial and protocol registration: Prospero registration: PROSPERO 06 June 2023 CRD42023425582. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023425582 .

Background: Primary care includes preventive and acute care, and management of long-term conditions. In Sweden, approximately 40 million annual visits are made to primary care, of which more than 12 million are registered nurse consultations. Registered nurses are often responsible for initial assessments, including triage and prioritization. Timely and accurate assessments are essential, as inappropriate decisions may adversely affect both care quality and patient outcomes. However, demographic changes, rising chronic disease prevalence, and growing expectations for accessible and efficient services continue to strain primary care capacity. Therefore, this study aims to explore registered nurses’ experiences of goal conflicts in decision-making during primary care consultations for acute illnesses, with a focus on clinical assessment, prioritization, and their perceived consequences. Methods: A qualitative study using semi-structured focus group discussions was conducted to explore registered nurses’ experiences and perspectives. Seven focus group discussions with 27 registered nurses in Sweden were conducted between April and May 2025. A thematic analysis was conducted. Results: The results present one overarching theme, Juggling conflicting demands of optimal and timely care with limited resources , and four interrelated themes illustrating these goal conflicts: organizational demands versus quality of care , accessibility versus risk of crowding out , expectations versus adequate resources , and teamwork versus professional autonomy. The findings highlight conflicting organizational, professional, and patient-driven goals that result in ethical dilemmas and ambivalence among registered nurses. Conclusions: This study indicates that goal conflicts in primary care arise from extensive assessment responsibilities placed on registered nurses without adequate alignment with education, competence, and organizational support. Despite extensive responsibilities for clinical assessment, decision-making, and prioritization, registered nurses have limited influence over organizational conditions, creating an asymmetry between responsibility and authority. These findings suggest a need for improved alignment between roles, competence, and organizational support.

Background: To effectively utilize available healthcare resources, integrated care models are recommended. According to such model’s, registered nurses have the potential to increase patient access to health care services and alleviate organizational workload. Studies on acute home consultation assessments by registered nurses are sparse. The aim was to describe the reasons and actions for unscheduled same-day face-to-face registered nurse consultation at home offered to patients calling the national telephone helpline for healthcare in Sweden (SHD 1177), according to the integrated Collaborative Health Care model. Methods: A descriptive cross-sectional study was designed. Data from registered nurses (n = 259) working within the Collaborative Health Care model, who performed unscheduled consultations at home (n = 615) using a data collection tool from 2017 to 2018 were collected. Results: Among the 615 unscheduled home consultations performed by registered nurses, > 50% of the patients were managed at home as their health problems were not deemed as requiring a same-day referral to a clinic when assessed by the registered nurses. The most frequent health problems and reasons for contact were urinary tract problems, followed by medical and surgical conditions. Social factors, including living alone, impacted referral. Those living with a partner received care at home to a greater extent than those who lived alone. Conclusion: An integrated model for healthcare involving registered nurses direct assessment, action and accountability seems to be an efficient option for providing integrated care at home and reducing acute clinic visits.

Background: A major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses’ initial assessment of patients’ health problems in primary care, examine working mechanisms in good practices and develop feasible solutions. Methods: Project PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses. Discussion: This research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients’ level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses’ communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care. Trial registration: ClinicalTrials.gov Identifier: NCT06067672.