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Background: Norway’s community nursing service is the country’s largest primary care provider, and user numbers are increasing. The way that the community nursing service is organised may contribute to improving or reducing safety and the quality of care. The Government favours an evidence-based organisational model. Objective: This study was conducted in order to increase our knowledge of how municipal decision-makers justify their choices, and how they describe and accentuate quality, patient safety and health promotion with respect to the organisation of the community nursing service. Method: The study is based on a comparative case study of two Norwegian municipalities. We gathered data by conducting focus group interviews with local councillors in each of the municipalities and individual interviews with the respective heads of municipal healthcare services. We also retrieved a number of municipal documents. We subjected the material to an inductive content analysis and compared the data obtained from the two municipalities. Results: Formal recommendations put forward by the municipal administration have a significant impact on how the community nursing service is organised in each municipality, while evidence-based knowledge and health promotion are of limited importance. Concerns for quality and safety have a moderate impact in one of the municipalities, while they have little impact in the other. There appears to be considerable distance between the levels of decision-maker and patient. Conclusion: The study shows that the organisation of community nursing services is complex and fragmented, and there is reason to ask whether the organisation of services allows for fulfilment of legal requirements pertaining to quality and safety.

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