Table 5 Effect of nurse attitudes to risk on proportion of calls sent to self care: odds ratios* based on 211 nurses making 231,112 calls, with numbers of nurses in each category in brackets

Risk tolerance in clinical decision-making

1. When in doubt it is preferable to refer to a service than to wait and see

1 (22)

1.05 (102)

1.00 (40)

0.86 (44)

- (1)

0.001

2. An NHS 24 nurse must prefer the certain to the uncertain

1 (16)

1.39 (73)

1.22 (55)

1.36 (53)

1.24 (5)

0.001

3. An NHS 24 nurse must not take any risks with physical illness

1 (58)

0.67 (97)

0.95 (21)

1.02 (32)

- (0)

0.06

4. For physical complaints an NHS 24 nurse should do everything possible to establish the cause of a complaint

1 (34)

1.01 (97)

0.63 (23)

1.32 (48)

1.05 (4)

0.002

5. As an NHS 24 nurse you must always be aware that each complaint might be the beginning of a serious illness

1 (31)

0.92 (108)

0.42 (30)

0.81 (37)

1.62 (4)

0.09

Competing expertise of nurse and computer

6. I prefer to use a clinical algorithm than to assess calls on my own

1 (13)

1.09 (52)

1.26 (53)

1.69 (81)

1.20 (10)

0.001

7. It is best to avoid overriding clinical algorithms unless absolutely necessary

1 (4)

0.95 (41)

0.99 (35)

1.47 (112)

1.36 (17)

0.001

8. The most important thing is to follow the agreed algorithms

- (0)

1 (15)

0.84 (48)

1.05 (119)

0.97 (27)

0.20

9. I often feel I know better than the clinical assessment system

1 (7)

1.01 (46)

0.96 (89)

0.91 (57)

0.83 (7)

0.002

10. Intuition or gut reaction plays an important role in my clinical decision making

1 (32)

1.09 (132)

0.72 (29)

0.92 (18)

1.00 (2)

0.001

11. I have strong views on where particular patients should be advised to go

1 (11)

1.53 (83)

1.13 (80)

1.41 (34)

1.38 (2)

0.001

Competing risks between missing illnesses and overloading services

12. It is important not to overload busy services

1 (53)

1.00 (101)

1.01 (29)

0.98 (24)

1.28 (1)

1.00

13. To be safe, it is better to send 100 patients to a service unnecessarily than to leave one at home who needs care

1 (4)

0.59 (26)

0.52 (37)

0.61 (118)

0.60 (24)

0.11

14. I feel that nurses in NHS 24 tend to send more patients to services than is really necessary

1 (9)

1.36 (66)

0.93 (55)

1.33 (72)

0.99 (7)

0.005

General

15. I tend to be quite a cautious person

1 (14)

1.38 (88)

1.48 (63)

1.32 (41)

- (1)

0.001