Bibliografisk note

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In the present study physician responses were of a dual nature. On the one hand, they acknowledged that nurse-led consultations freed up their time and resulted in their professional skills being used more efficiently, providing the hospital with an organisational advantage, but on the other hand ultimately leaving the physicians to handle more complex and time-consuming cases in the outpatient clinic. Nurse-led consultations are often highlighted for their ability to ease work pressure on medical consultants (Kerr et al., 2021), but other studies have shown that their workload has become more stressful due to the additional supervision and training required for CNS (Evans et al., 2021). This creates a challenge since CNS may need to discuss patient cases during the day, though they are reluctant to disturb the physician, and the outpatient clinic's current setup does not support inter-professional discussion.The physicians mainly assessed CNS skills and knowledge positively, and all of them felt comfortable about referring patients to nurse-led consultations, which is in contrast to Farrell et al. (2017), who identified resistance among physicians toward using nurse-led consultations. Farrell et al. (2017) also described that referrals were based on the relationship between CNS and the physician. This was not the case in our study suggesting that physicians in our study afforded CNS sufficient professional respect. CNS in our study appreciated that there was solid, respectful interdisciplinary cooperation, which has been shown to have a genuine impact on the role and autonomy of CNS in facilitating nurse-led consultations (Farrell et al., 2017). The physicians thought CNS were skillful, but CNS felt they had an immense responsibility to not overlook anything serious, e.g., a critical lab test, and this pressure was even greater if the patient did not follow a standard regimen. As a result, CNS relied on guidelines to support their clinical practice. Concern about making mistakes is a topic that similar studies of nurse-led consultations, to our knowledge, have not yet examined. Nurse-led consultations created new challenges for CNS, e.g., how to find time to discuss patient cases with physicians and whether patients’ pre-consultation knowledge of the time frames influences the actual consultation time and/or patient related outcome. Based on our study and research (Lindfors et al., 2019) we recommend to provide the patient on the specific time frame for consultations to clarify and align expectations (Fortin VI AH et al., 2012), just as prioritising interprofessional discussion, a highly valued process, is warranted to ensure that CNS provide optimal patient care.Nursing research grant, Department of Oncology, Copenhagen University Hospital, Rigshospitalet.

Funding Information:
Nursing research grant, Department of Oncology, Copenhagen University Hospital, Rigshospitalet .

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