Trying Telephone Triage

Any nurse who has worked in an urgent care setting will tell you that it is invariably the most severely ill/injured patients who say, I wasn’t even sure I should come in for this, (and this could be anything from kidney stones to an MI to a deep puncture wound) and are the most apologetic about taking up your time and being a nuisance, while those who present with hangnails and cold sores are the most apt to complain, loudly and vehemently, about long wait times and not getting the brand-name antibiotic they are sure they need. What if you, as a nurse, could help ensure that people who need emergency care seek it, and help those not requiring immediate treatment understand their conditions and find appropriate care in the near future? Perhaps telephone triage nursing is a career option for you.

Telephone triage nurses are employed by health insurers, HMOs, physicians offices and hospitals as a front line resource for patients who have questions about changes in their health and what kind of treatment they should pursue. Telephone triage nursing is different than health advice lines offered by insurance companies, health care facilities and municipalities, which exist to provide answers to general medical questions. Telephone triage aims to advise patients regarding appropriate treatments for their current symptoms and decrease the number of unnecessary office and emergency room visits.

Telephone triage services rose to prominence in the U.S. during the mid-1990s in response to the overwhelming numbers of non-urgent cases presenting at emergency departments. The idea was adopted by physicians offices as a way of advising patients who called with concerns during or outside of office hours where, when or if to seek medical attention. Because of the special challenges involved in telephone triage nursing, it takes a certain kind of nurse to enjoy the job and meet its goals.

Obviously, evaluating a patient over the phone is a different experience than triaging a patient in the ED. With no physical assessment and lacking the non-verbal cues and diagnostic equipment that help a nurse understand a patients complaint, the telephone triage nurse must rely on excellent communication and interpersonal skills. It requires an in-depth knowledge of disease processes applied in conjunction with critical thinking and judgment, although the telephone triage nurse does not provide a diagnosis. The phone triage nurse assesses the information given by the patient, asks questions and guides the patient to the appropriate care.

Telephone triage is provided by RNs, generally those with extensive hands-on triage experience or who have taken classes that specifically teach pone triage skills and protocol. Ongoing education is usually part of the job. Performing telephone triage nursing has unique pros and cons. On the plus side, nurses deal with a varied caseload, work regular hours, may even be able to work from home rather than at a call center or medical facility and the job itself is not physically demanding  there is no heavy lifting or clean-up. Negative aspects of telephone triage include the lack of personal contact with patients, no follow-up with patients, no real interaction with colleagues, heavy computer/paperwork load and a sense of isolation or disconnect. One must have the proper skills, mindset and personality to succeed and thrive as a telephone triage nurse.

Certification is not usually required for working as a telephone triage nurse. However, many employers see this as a reflection of competency and professionalism that then increases the appeal of a job candidate. The National Certification Corporation now offers certification in Telephone Triage. As with most other certifications, there are certain eligibility requirements, such as current licensure, 2000 hours of specialty experience and recent employment in the specialty if applicable

The Emergency Nurses Association (ENA) notes in their Position on Telephone Advice that as health care changes in this country, the demand for telephone assistance is climbing. It advises, however, against nurses performing such functions without an established telephone triage program and without appropriate education, asserting that the consequences of nurses giving phone advice can be devastating in the absence of polices, protocols and documentation. There can be negative outcome for patients as well as risk to the facility and violation of state nurse practice acts if telephone triage services are improvised. ENA recognizes that sophisticated telephone triage programs provide quality health care assessment opportunities that enhance and promote quality health care within the community, but caution that proper expertise, training, documentation, continuing education and clearly defined policies and quality control standards are essential in assuring that telephone triage does more good than harm.

If youre looking for a non-traditional way to use your nursing skills, telephone triage is an ideal example of a way nurses assist the community in a setting other than direct patient care or administration. Dont be fooled into thinking that triage nursing is an undemanding job. On the contrary, a shift at the phone on a triage line can be more demanding than a day running up and down the medical/surgical floors. The major difference is that the delivery of top-notch nursing care must come without the advantage of seeing or touching the patient.

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