Table 3

Qualitative, free-response data from both surveys

ThemeRespiratory nurse specialist quote
1. Breadth of service provided‘The service commissioned by our clinical commissioning group is purely community but our managers and respiratory consultants try to get us to provide an acute service on top of this, it makes it very difficult to manage our time and prioritise. The patients referred to our community service are waiting longer and longer to see us.’ (Nurse survey)
‘…plugging gaps for nurse shortages on the wards’. (Organisational survey)
‘…commissioners have varying expectations’. (Nurse survey)
‘Respiratory nurses are expected to cover everything’. (Nurse survey)
‘Please note that our team is made up of respiratory specialist physiotherapists along with respiratory nurses and an occupational therapist. We cover all the same services but do have specialist physio clinics for ambulatory oxygen assessment and chest clearance’. (Organisational survey)
2. Patient care‘We are extremely stretched’. (Organisational survey)
‘Currently experiencing high demands in workload as community patients become more complex with limited staff, so unable to carry out education due to time constraints’. (Nurse survey)
‘I worry that my role as mainly preventative upstream work will be lost to the firefighting seen in hospital. Consequently denying my patients the opportunity to embrace and develop their self-management skills; this will increase the workload in secondary care. Again that quality care will be lost’. (Nurse survey)
‘Asthma appointments are too short. It is impossible to give all the care required in 20 min’. (Nurse survey)
3. Working environment‘I have been fully supported over the years. However, the workload is increasing dramatically but we do not have enough respiratory specialist nurses in place to cope with the demand. The hospital seems to be reluctant to approve any nurse specialist posts due to financial pressures’. (Individual nurse)
‘Currently a single-handed respiratory nursing service with no admin support, holiday, unplanned absence cover’. (Organisational survey)
‘…currently a full-time member of staff down…struggling to get management to employ someone so quite a difficult time at the moment’. (Nurse survey)
‘There is minimal admin support for the acute and community teams given the number of nurses and the size of the caseloads/activities’. (Organisational survey)
‘We have administrative support for oxygen services. Everything else is completed by the CNS (clinical nurse specialist) team’. (Organisational survey)
4. Succession planning‘Over the past year the service has changed to a new team due to retirement and so we are in the process of sorting out new leads for the different conditions’. (Organisational survey)