Table 5.
Effect of nurse attitudes to risk on proportion of calls sent to self care: odds ratios* based on 211 nurses making 231,112 calls, with numbers of nurses in each category in brackets
| Items groups by original concepts of risk | Strongly agree | Agree | Neither | Disagree | Strongly Disagree | p-value |
| Risk tolerance in clinical decision-making | ||||||
| 1. When in doubt it is preferable to refer to a service than to wait and see | 1 (22) | 1.05 (102) | 1.00 (40) | 0.86 (44) | - (1) | 0.001 |
| 2. An NHS 24 nurse must prefer the certain to the uncertain | 1 (16) | 1.39 (73) | 1.22 (55) | 1.36 (53) | 1.24 (5) | 0.001 |
| 3. An NHS 24 nurse must not take any risks with physical illness | 1 (58) | 0.67 (97) | 0.95 (21) | 1.02 (32) | - (0) | 0.06 |
| 4. For physical complaints an NHS 24 nurse should do everything possible to establish the cause of a complaint | 1 (34) | 1.01 (97) | 0.63 (23) | 1.32 (48) | 1.05 (4) | 0.002 |
| 5. As an NHS 24 nurse you must always be aware that each complaint might be the beginning of a serious illness | 1 (31) | 0.92 (108) | 0.42 (30) | 0.81 (37) | 1.62 (4) | 0.09 |
| Competing expertise of nurse and computer | ||||||
| 6. I prefer to use a clinical algorithm than to assess calls on my own | 1 (13) | 1.09 (52) | 1.26 (53) | 1.69 (81) | 1.20 (10) | 0.001 |
| 7. It is best to avoid overriding clinical algorithms unless absolutely necessary | 1 (4) | 0.95 (41) | 0.99 (35) | 1.47 (112) | 1.36 (17) | 0.001 |
| 8. The most important thing is to follow the agreed algorithms | - (0) | 1 (15) | 0.84 (48) | 1.05 (119) | 0.97 (27) | 0.20 |
| 9. I often feel I know better than the clinical assessment system | 1 (7) | 1.01 (46) | 0.96 (89) | 0.91 (57) | 0.83 (7) | 0.002 |
| 10. Intuition or gut reaction plays an important role in my clinical decision making | 1 (32) | 1.09 (132) | 0.72 (29) | 0.92 (18) | 1.00 (2) | 0.001 |
| 11. I have strong views on where particular patients should be advised to go | 1 (11) | 1.53 (83) | 1.13 (80) | 1.41 (34) | 1.38 (2) | 0.001 |
| Competing risks between missing illnesses and overloading services | ||||||
| 12. It is important not to overload busy services | 1 (53) | 1.00 (101) | 1.01 (29) | 0.98 (24) | 1.28 (1) | 1.00 |
| 13. To be safe, it is better to send 100 patients to a service unnecessarily than to leave one at home who needs care | 1 (4) | 0.59 (26) | 0.52 (37) | 0.61 (118) | 0.60 (24) | 0.11 |
| 14. I feel that nurses in NHS 24 tend to send more patients to services than is really necessary | 1 (9) | 1.36 (66) | 0.93 (55) | 1.33 (72) | 0.99 (7) | 0.005 |
| General | ||||||
| 15. I tend to be quite a cautious person | 1 (14) | 1.38 (88) | 1.48 (63) | 1.32 (41) | - (1) | 0.001 |
*adjusted for age and sex of patient and time of call