Rationale In The Netherlands multidisciplinary care for inpatients with rheumatic diseases is quite common. It is generally recognised that this kind of care is necessary to fulfil the treatment goals. Within the University Medical Centre Nijmegen the multidisciplinary meetings are not only scheduled for inpatients, but also for outpatients. This way the continuity of treatment and care will be positively influenced.

Objective In order to propagate and let more patients benefit from this kind of care, we will describe the role and input of the nurse practitioner in the multidisciplinary team.

Patients and methods At our outpatient clinic the multidisciplinary meetings are scheduled once a month. The team consists of rheumatologists, social workers, occupational therapists, and the clinical nurse specialists. All team members have the possibility to add their case (s) to the agenda for discussion. Generally these are patients with more complex problems, necessitating optimal co-ordination of treatment and care.

The discussion and decision making process take place on the ‘base of equality’. In our team, each member’s knowledge and experience are respected and applied. This equality of disciplines is required to guarantee optimal quality of the multidisciplinary care.

The role of the clinical nurse specialist consists of:

• representing the patients by clearly explaining their questions and problems

• input of her expert opinion to the multidisciplinary treatment approach

• advising the colleagues in the clinic as well as the primary health care

• making a working schedule and point out priorities, based on the planned treatment approach.

Conclusion The clinical nurse specialist is more and more an expert with a crucial role in patient care. Within the multidisciplinary team, an open relationship between physicians and health professionals is an important condition for good quality of the decision making process.