Reach Out and Nurse Someone The Art of Telephone Triage Nursing
Saturday June 1, 2002
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Telephone triage is becoming more recognized in the field, and it is a wonderful option for experienced nurses. You'll find telephone triage nurses in managed care companies; providers' offices; hospitals; poison-control centers; and working suicide, crisis, and abuse hotlines. The goal of these companies may be to control financial expenditures, reduce unessential ED visits, save patients time and money, promote a better quality of life for patients, and to use physician offices or self-care measures.
Remember, an informed patient is a healthier patient. Telephone triage requires experienced RNs who do a thorough assessment and then consult with patients to determine the urgency of care necessary for them at that time. Telephone triage nurses also educate patients about their health, explain their options, and advise them about health concerns. In some situations, if a person has a general medical question, he or she can be transferred to an audio library to listen to the topic of choice. Nurses can also counsel patients when their providers have offered them more than one care option.
Get off Your Feet
Telephone triage nursing involves long hours sitting at a desk using the telephone. Regular shift hours are set depending on the hours of operation. Depending on the area or population served, a translating service or multilingual nurses may be used, as well.
Telephone triage nurses need a high level of experience to function effectively. Some companies recommend five years, others, 10 years. An ED background treating pediatric and adult patients is extremely helpful, as is knowledge in multiple areas of nursing. Solid clinical skills are necessary to determine which plan of care is appropriate for the patient. In addition, continuing education is essential to increase knowledge and keep abreast of current trends in healthcare, health information, and practices.
Nurses need good spelling skills and the ability to type swiftly to do this work. They also have to think quickly, thoroughly, and critically. This means listening carefully, asking the proper questions, and extracting hidden agendas from the patients. A compassionate and empathetic approach is necessary to achieve this. Additionally, because of the extensive computer use, proper body mechanics and ergonomically designed office furniture is required to prevent worker injury.
Good telephone triage centers have quality-assurance programs that monitor clinical performance and customer satisfaction. Statistics are kept regarding the number of calls a nurse receives, the length of each call, the abandonment rates, how quickly calls are answered, and call completion times. A telephone triage accrediting institution then uses this data to determine accreditation status and other factors.
Calling upon All Nursing Skills
Like most nursing professions, telephone triage can be a 24/7 service, so many nurses work nights, holidays, and weekends. Unfortunately, many have to deal with perverse callers, chronic callers who are just lonely and want a friendly voice to talk with, rude patients, and cursing. If profanity occurs, the call must be terminated. Assertiveness is vital to function effectively in this field.
Call records may be faxed to a patient's provider following the triage encounter, but all records are maintained at the center as a permanent record. Some triage centers contact patients' physicians for them while others have patients contact their primary care providers when the triage nurses deem it necessary. Follow-up calls are done on all patients who were determined to need ED treatment and on those who were referred to poison control.
Telephone triage nurses must pay attention to the legal aspects of this type of nursing, particularly the center's specific policies and procedures. They also must be familiar with their states' nurse practice act and state laws relating to telephone triage. Protocols/algorithms that are current and have been approved by a medical director, who is a physician, have to be followed.
Telephone triage nurses must ask their patients questions to rule out life-threatening symptoms, determine the acuity level of each patient's condition, and sort out our own feelings. To do this nurses must avoid stereotyping, be open to information from patients, and avoid judgment. Some companies record calls, and depending on the state's laws, the recordings can be used during litigation. Last but not least, nurses can never diagnose, but can always assess the patient.
A Personal Call
All in all, I have found telephone triage very interesting and quite fun. The feeling of imparting your knowledge to others in a way they can understand and hopefully comply with is a great feeling.
Another colleague at our sister call center in Columbia, MD, Patty Sadler, RN, sums it up best when she wrote me: "This is the perfect job isn't it? Other than being tied to a phone, this job brings a variety to life!" Lastly, she said this job is "easy on the feet, easy on the back." You can't get much better than that.
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