Monday, July 30, 2018

Telephone Triage Is Not Right for Everyone

You may be considering a remote telephone triage position, and don’t know if it is the right fit for you. Telework nursing is not for everyone, and the characteristics of a successful remote employee should be considered.
Many people are very social and need considerable interaction with co-workers to remain happy in their position and to feel fulfilled. Telephone triage would not be an ideal position for those who thrive on social interaction on a daily basis. On the other hand, it is usually not a good fit for those who describe themselves as loners either. An isolated environment, such as the telephone triage role, could be detrimental to a nurse who already is limited themselves with social contact. It would   exacerbate pre-existing social problems.  Telephone triage is ideal for those nurses who enjoy working alone, but do not limit themselves from having contact with others.
Telephone triage nurses need to be self-starters. They must possess a strong work ethic and not require close supervision to get the job done. Working remotely does not mean a chance to fool around or that there is no pressure. Experienced, remote telephone triage nurses understand this. The entire system would not function without self-starters in these positions.
Telephone triage nurses must be technology competent. Working remotely requires you must be proficient in the use of computers as it is required for the job and communication. This could include specialized software programs, instant messaging, desk-top faxing, emails and appointments functions, tele web conferencing and any other tools that the nurse may be required to use. The successful telephone triage nurse is not afraid of technology, because if something goes wrong, they must be able to trouble shoot it and know how to fix it or where to go for help.         
There is not a specific minimum number of years’ experience that one would say is required to work in a remote telephone triage experience. However, new graduates would not be a good fit for such a position, because it requires competence, expertise and knowledge beyond that which is obtained in a basic nursing program.  Research has shown that triage assessments are done better by those with more experience, more education, and more training. Interesting also, researchers have suggested that extensive life experience such as raising kids, caring for aging parents, and running a household may also be valuable.

Wednesday, February 28, 2018

What is Telephone Triage?

The term triage is french in origin, and refers to the process of sorting. The original concepts of triage referred to mass casualty situations, such as during war times. Triage, by definition, is a dynamic process as the patient's status can change rapidly.
With the evolvement of various triage systems, it is easy to forget that triage is still the central focus, and telephone triage is essentially like operating an ED triage area over the phone.
Telephone triage starts at the point of intake, or when the patient or caller makes the initial phone call. It is important that the first person they make contact with has good listening skills, is able to discern the main focus of the problem, and either route the call appropriately or take a complete message. If a message is taken incorrectly, valuable time could be wasted, as the telephone triage nurse might not be able to discern this is actually an emergency call. Accuracy is extremely important.
From that point, the concepts of triaging, sorting into priority, remains sound and unchanged and cannot be done by just anyone accurately. It requires someone who is medically trained and able to recognize what is an emergency and is capable of assessing over the telephone. If the telephone triage nurse is working from a queue, they must have the ability to sort out what is emergent, urgent and then non-urgent. This is where the basic concepts of  ABC's comes into being. As in any triage situation, airways, breathing, and then circulation are the main priorities. Those calls should be taken first, and then more sorting of the remaining calls should follow. Non emergent calls such as rescheduling appointments or medication refills should be considered non urgent.
Once the calls are sorted and the nurse is in the process of the call, what is the next step? Again, true triage is sorting through the information being provided by the caller to determine the next step. In order to gain enough information, the telephone triage nurse should be able to select and follow the correct protocol or guideline with assessing the patient. In order to be a truly skilled and effective telephone triage nurse, the nurse must be able to think outside the box, examine the larger picture and then narrow it down to the correct protocol. Appropriately selecting and adhering to the correct protocol ensures the best patient outcomes, however the skill is in being able to select correctly.
Next, an effective telephone triage nurse is able to discern the appropriate disposition, or next step, and that again falls into the emergent (emergency room), urgent (urgent care or be seen in provider's office ), or homecare (no follow-up needed unless symptoms worsen).
Many nurses, new to telephone triage, burden themselves with going above and beyond the next step, and with unnecessary details not pertinent to the current situation. This is not only non-efficient, but also can lead to burn out as it can be very overwhelming.
Telephone triage can be a very efficient process, and very beneficial in assisting callers if done in the correct manner.

Thursday, December 28, 2017

Why I am a Telephone Triage Nurse

As I was speaking with a friend and co-worker the other day, we talked about why we liked our job, and how we reap the benefits in our personal lives. We both agreed we would not have it any other way. That conversation has resonated with me since then, and I have been thinking about why we do what we do every day.
Thinking back to that conversation, on this cold December evening, I started remembering all the different nursing positions I have held in my career, and about the times I have had to have to go out at all hours to visit patients during my tenure as a home health/hospice nurse. I remember driving on back roads that were icy and snowy to make those visits, and even times, I parked my car, grabbed my bag, and walked in to see patients because it was just not safe to drive. I also remember, during snow storms, packing a change of clothes, telling my family I was not sure when I would be home, and catching a ride to the hospital to work my shift. All because that is what you do when you are a nurse.
Reminiscing about prior positions, different patients over the years have come to mind as well. There were patients that I can still remember their names, and there are some that their name is not so clear, but the bonds we developed, I will always cherish. There are also patients that I would rather forget because they were difficult, and well, let’s face, just mean.
Being a nurse does not come without injury at times either. You risk being bitten, hit, kicked, and God-forbid seriously injured by a patient who has serious mental issues. There are also risks of physical injury from the strain of lifting, bending and pushing objects that weigh more than they should.
When I discovered telephone triage nursing, I never knew such a position existed.  At that time, I was searching online for work at home positions for nurses. My mother had recently moved in because her health was declining, and I knew that I soon needed to be available for her more. Working outside the home was not going to be an option any longer.
I secured a position with a very small company as a contracted nurse. At that time, the pay scale was that of a new graduate, but it was not the pay I was seeking. It was the position.  Training was not paid, and I had to travel two hours one way to train with another nurse. The nurse, who was gracious enough to let me into her home, was very good at her job and made it seem so easy. I had no idea what I was getting myself into. I just knew I needed this to continue earning income. I was determined I was going to learn this position, and learn it well.
After my training was complete, my first shift on my own was a four-hour block. Admittedly, I did have illusions about working remotely as a telephone triage nurse and thinking how easy the position sounded. I quickly learned it was just that, an illusion.
I had my protocol books all laid out, and with each call, I was so focused that I do not remember even looking at the time until my shift was almost over. I also distinctly remembering I had one of the most severe headaches I ever had, and being exhausted! That is when I realized that although being a telephone triage nurse is not physically demanding, if performed correctly, it is the most mentally challenging positions you will ever hold.
As time went on, I challenged myself to learn other specialties I knew every little about. I had been an adult nurse most of my career, and now I was dealing with pediatrics and obstetrics as well. I wanted to sound to callers that I was self-assured and knowledgeable. Callers will not trust a triage nurse who does not seem to know the content of what they are speaking of.
At this point, I was enjoying my new found position. I liked the new challenges, and I also started to challenge myself to be more efficient. I admired my nurse manager, and I challenged myself to exceed her hourly completed calls. I am that kind of person who wants to excel in whatever I decide to do.
There was something else I was learning about this position. For the first time, in a long time, as a nurse, I felt appreciated. Not just by my employer, but by the callers. As I went from call to call, thoroughly assessing their complaints, finding the right protocols, and offering advice, I could hear the appreciation in their voices. Many openly expressed that appreciation. I thought I had seen all the areas of nursing there was to offer, but there is something about calling a patient’s home that seems to put you right there in the home with them. Their true emotions are exposed, and they seem to be less reserved like they might be in a facility setting.
Just like my experiences working in a facility setting, I have had some telephone encounters, working as a remote telephone triage nurse that forever changed my life. There are still the occasional difficult callers, but for every one of those, there are two who are appreciative.
Over the years, my position has allowed me to care for my mother until she passed away, home-school my children, be at school parties and functions as they got older and go to my own appointments without having to miss any work time. I have been able to work from the comfort of my own home without having to travel in bad weather, and even on days I have been ill  and would have otherwise had to be absent if working elsewhere.
I have been able to work between two homes and travel while working in this position, and ultimately, it has allowed me to be able to move to my dream home on the lake. It is located in a very rural area where positions are limited, and if not for this position, I would have to have waited until retirement to do so.
Lastly, the icing on the cake is the friendships I have developed. I have heard so many others say working at home is so isolating. It is isolating only if you allow it be. This is a wonderful opportunity to meet some great people from other cities and states that you would otherwise never have the privilege of knowing. We converse during off times at work, support each other, share facebook pictures and messages, have phone conversations, and sometimes even get the privilege of meeting face to face. Many have developed closer bonds than they have with their own friends or family who live locally.   
That is why I am a telephone triage nurse. It is not just a job. It is the opportunity to not only help someone, but possibly change their life. It is the opportunity to have a life that I love, and it is the opportunity to develop life-long friendships with awesome nurses who share the same vision.

Tuesday, December 12, 2017

What Traits Does a Successful Triage Nurse Have?

So many think that telephone triage nursing is an easy job. After all, it is just talking on the phone right? Wrong. It is so much more, and is one of the hardest nursing positions you could ever hold. You have to have the ability to "see" the patient over the phone and safely get them to the next level of care.
So, what does it take to be successful in this specialty?
1. The nurse in this role must be self directed. They must be sure of themselves and realize that although their role is limited, they recognize their importance. Flexibility is important, and they must possess a good work ethic.  This is often a very independent role, and  these qualities are a must.
2. The nurse must be be focused on the short-term goal and achieving short term results. They must possess excellent time management skills, and enjoy bite size pieces of information. They measure their success by reaching measurable outcomes.
3. The nurse must be a strong patient advocate.  They must be empathetic, have the ability to gain the patient trust, and be effective in their delivery.
4. The nurse must possess practical intelligence. Telephone triage is a constantly changing specialty. The effective nurse must enjoy learning and be a quick learner. They should also be able to  relate new information to previous knowledge and apply it when necessary.
In summary, the successful triage nurse must be able to prioritize medical emergency calls, explain lab/test results, draw on prior experiences and knowledge, use decision support tools effectively, and communicate effectively with the patient within the patient's level of understanding.
Is this the role for you? It is not for everyone. However, it can be one of the most rewarding specialties in nursing if you possess these qualities.

Thursday, September 28, 2017

The Interview Process

With telephone triage, the caller has no idea what the nurse is doing or if they are even listening, and it is imperative that the interview process be successful. It completely determines the outcome of the call. There are some things the nurse can do to enhance the quality of the interview and guide the call to a successful outcome.
First, explain long silences to the caller. You can state "Thank you for the information. I am just getting it all documented", or "Give me a minute to think to make sure we are not overlooking anything". Callers will appreciate knowing that are you listening and not doing something else.
The caller should receive the upmost attention, but if you have to place them on hold for any reason, explain why and thank them for holding. If you have to keep them on hold for more than 2-3 minutes, you should come back them and  explain why the extended hold, and apologize.
Don't chew gum or eat while on the phone. That is self explanatory and is unprofessional.
Call the patient by name. Most people prefer to be called by their first name, but we should never make that assumption. It is professional to ask patients if you have their permission to address them in that manner.
Be real to the caller. Give each caller the personal touch. Speak to each one warmly rather than in an automated tone.
Finally, the most important thing to remember is put yourself in the caller's shoes. We as nurses, have an understanding of how the body works and about health conditions. If we are sick, we understand the symptoms and what is happening. However, equate this to someone who does not even understand what the term fracture means. Listen to the caller, be patient, and try to remember what it was like before you became a nurse.
Studies comparing providers who have been sued comparing to those that have never been sued showed that those that were never sued spent just a couple of extra minutes with the patient, showed concern, were accessible, were good listeners who invited questions, got the exam out of the way first, asked open ended questions, used humor, involved the family, explained and checked for understanding, negotiated, expressed interest, and encouraged conversation. These are all qualities that would serve telephone triage nurses well.

Wednesday, August 2, 2017

Recipe for a Successful Call

If you have been a triage nurse for any period of time, you can remember at least one call that you just felt like was not successful. It could be that the caller was frustrated with previous encounters with medical personnel, too anxious to really listen to your advice, or maybe you felt like you were not prepared enough. Yes, there is always at least one that sticks out in your mind.
How do you prevent that from happening again? There are some steps to follow to ensure both you and the caller are pleased with the outcome.
1. Be familiar with your facility or company's adapted protocols or algorithms. Know where and how to access the correct protocol quickly and efficiently. If you cannot do so, the caller will know you are not prepared and will have decreased confidence in your abilities and be less likely to follow any advice you give.
2. Be able to draw on your own knowledge and past experiences. There are appropriate times to interject additional education and information to assist the caller with getting to the next level of care.
3. Develop a relationship with the caller. This is probably the most important thing you can do to ensure a positive outcome. Callers are seeking medical advice, but they also want to know they are being heard. It is important to really listen to what they are saying and be empathetic, even if it means you have to stop typing for a moment to give them your undivided attention. We often get so focused on gathering information that we may not realize that callers pay attention to what they hear as well. I had a caller say to me once, "Can you please just stop typing for a minute and listen to me?" I was listening to her, but because she heard the sound of my fingers hitting the keys, she felt she did not have my undivided attention. They do not care how much you know until they know how much you care.
4. Educate the caller. Don't just be the person who hands out advice. Explain why you are recommending the disposition. Explain risks of not complying. Instruct them on red flags to watch for and when to call back.
5. Finally, ensure them they are not alone. Let them know that help is just a call away, and they can call back at any time if they have further concerns or questions.
There is nothing like the feeling of success when you disconnect from the caller knowing they are appreciative of the conversation you just had, and knowing you were able to help in their time of need.

Tuesday, June 13, 2017

The Triage Nurse's Role as a Detective

A skilled triage nurse knows that every call he/she receives should never be taken for face value. So many times the initial complaint may be one symptom and turn out to be something completely different, and potentially serious.
Here is a good example of this. The initial message from the answering service came in as infected bug bite. The nurse, being as diligent as she was, pulled up the insect bite protocol, and returned the mother's call. The mother stated the child had an insect bite for a couple of days and was showing symptoms of infection. The child was complaining that morning of not feeling well. The mother is a diabetic, but the child had never had any diagnosis so the mom decided to check the child's blood sugar just to see and it was over 300. Now the call had just taken a 360 degree turn. It had gone from what seemed simple, and could be treated the next day in the office to an immediate emergency room referral.
This situation would be a good example of the skill and expertise that is needed to be a triage nurse, and why unlicensed personnel should not be in this role. It also requires a variety of experience to be able to recognize that the biggest problem was not the insect bite, but the child could potentially be an undiagnosed Type I diabetic. It also then takes knowledge to know where to locate the correct protocol and chose the correct plan and disposition.
An experienced triage nurse knows what assessment questions to ask to determine the issue at hand, and has excellent listening skills to be able to determine if a small bit of information elicited from the caller could be something that needs to be investigated further. They interview, investigate, listen to the caller, listen for background noises that could potentially help, such as the quality of the cough from the child that the parent could be calling about, and then, they are able to take all that information and determine a plan that is the safest and most effective for the patient.
Being a skilled triage nurse means being a skilled detective.