Expanding the nurse's role to improve preventive service in an outpatient clinic.

To help resolve the conflicting demands of primary and secondary care in hospital medical clinics, a program was developed whereby, with the physicians' agreement, nurses would select and vaccinate clinic patients eligible for influenza vaccination. In a controlled trial the nurses offered vaccination to half of the eligible patients attending morning sessions and vaccinated 35% of them. In contrast, physicians in the afternoon sessions, who were unaware of the program, vaccinated only 2% of similar patients. These results show that, although these physicians agree with guidelines for influenza vaccination, they are not currently providing the service. The use of nursing personnel to provide this and other types of primary medical care for clinic patients is a reasonable alternative.