Table 2 Overview of the results of the content analysis of the focus group discussions

Changed preconditions in PHC motivate new work models

Patients’ expectations of health care have changed

The resources in PHC, i.e. staff and premises, are not adapted to new conditions

One problem is that our patients do not know their diseases and symptoms, instead they seek emergency care at the PHC centre.

There are so many changes that just arise at this PHC centre. For us PHCNs, it feels like we remain behind on the platform when the train passes by.

The triage and Nurse on Call model improves teamwork and may increase the quality of care

Triage and Nurse on Call increase patient safety

Triage and Nurse on Call increase patients’ accessibility to health care

When you follow a decision support tool it feels like increasing patient safety.

We work closer together and across boundaries, especially between physicians and RNs.

Unclear purpose and vague leadership make introducing the work model difficult

Unclear purpose at introduction

Vague leadership and insufficient organizational support

Everything was fine until things [the work model] were tightened up one year ago. Since then we PHCN no longer can book appointments to physician on call although we want to.

When we try to say what we think about the work model with triage and Nurse on Call the manager literally says, “We will not turn back.

Before, when we had no real rules, you did what you thought was right.

Difficulties to adopt the work model as it challenges professional autonomy

The approach of optimizing the use of the health care professionals’ competences is questioned because of the strong tradition of work in PHC being physician-centred

The changed working method questions how nurses have traditionally worked in PHC

Sometimes you set up a direct consultation with the physician on call … to spare the patient the nurse on call consultation, which doesn’t lead to anything anyway.

Problems arise when some of the telephone nurses book as they wish instead of following the decision support tools.

The triage and Nurse on Call model requires more knowledge and competence from nurses in PHC

Lack of correspondence with nurses’ experience, knowledge and competence

Expanded responsibility and more advanced tasks for nurses

When you advise patients over the phone, you learn to listen between the lines and to listen to your own gut feeling.

When we introduced the work model, it was important to think in a different way. So we had a facilitator at the PHC centre available every day. She was experienced in working as a nurse on call. Today, that kind of support is no longer available.

Registered nurses and PHCNs need to get more education before starting with the new work model where they’re expected to take more responsibility.