Primary health care nurses' views on patients' abilities and resources to make choices and take decisions on health care

Recent health reforms in many European countries have emphasised patient choice as a tool for patient participation, and for the improved efficiency of services. Little attention has been paid to experiences of the nurses in these reforms, even though the reforms directly concern all health care personnel and cannot be implemented without their contribution. This study looks at patient choice from the perspective of the nurses working in primary health care clinics in Finland. In Finnish primary care, nurses have a central role in coordinating patient care and advising patients. The data come from 31 interviews conducted in 17 health care clinics. The approach adopted in the analysis is data-driven and brings forth nurses' experiences in their daily work with patients. A detailed analysis of the nurses' responses and views was conducted with discourse analysis. While nurses positioned some patients as knowledgeable, able to search for information and make use of different services without nurses' help, some of the patients were positioned as those needing nurses' advice and guidance through the complex system of health and social care services. Nurses' positions varied from co-actors and gate-keepers to advocates and spokespersons. In order to succeed future health care reforms need to take better into account the realities of health clinics and the grassroots-level knowledge that primary care nurses have on patients and clinical practices.