Monday, July 26, 2010

Taking Control of The Call

To be an effective telephone triage nurse, you must not only give accurate advice according to the protocols, but the call must also be completed in a timely manner. Most calls can be completed in 3 to 5 minutes. Some of the more complicated ones, such as those you have to page a physician for, can sometimes take as long as 15 min for more.
In order for the call to be completed in that 3 to 5 minute window, you must take control of the call from the first second the caller answers. Let's examine further how to accomplish that.
First things first. Get the housekeeping stuff out of the way. By that, I mean verifying spellings, dates of birth, etc.(Make sure the demographics are correct.) Nothing messes with a billing statement more than to have 1 patient with 4 different spellings of the name. Also, with varied accents, and telephone reception, many letters sound the same. So, when you have similar letters such as "d" and "b", it is always a good idea to verify using examples. For instance, you can say, "Do you spell Abby, A, b as in boy, b as in boy, y?". This decreases errors dramatically.
Next, in obtaining the medical history, it is not necessary to obtain all of it, just what is pertinent to the current situation. Medications and allergies should also be obtained and this could include any OTC medications that the pt is taking.
There are certain questions that you should never ask in order to keep the call under control, and quickly gather the assessment information that you need. You should always ask questions that require short, quick responses if possible. One question that should be removed from your vocabulary is, "Tell me what is going on tonight". That leaves the caller wide open to give you any information they want including information that may not obtain to the situation at hand. This leaves you taking longer time trying to decipher what information you need and what you don't.
Stick to the questions in the protocols. If you ask all of those that pertain, you will have a complete picture of what is really going on, and the information will be obtained in a lot less time. If the caller starts to wonder off in the conversation, you can redirect politely by saying, "Let's get back to that in a second.I need to ask you some questions first".
Make the call flow from beginning to end, just like your documentation. Gather all of your assessment information before giving advice. If you skip around, you may miss some valuable bit of information, plus it adds more time to your call. And, by continuously asking all the questions in the protocols, it does not leave time for the caller to think of unnecessary information to tell you.
Finally, smile and be reassuring! Explain to the caller why you are giving the advice that you are. This is the time to educate, but keep it in understandable, layman's terms. Reassure them that they are not alone, and instruct them when they need to call back and what to watch for. If you are reassuring and give them all the information they need to feel empowered, they are more likely to give a good report back to their physician and less likely to call back several times in the same night with more concerns or questions on the same issue.

Saturday, July 17, 2010

I Am A Telephone Triage Nurse

I love it when I meet someone that asks me about my job. If you tell them you are an R.N., the first thing they think is that you work for a hospital somewhere. I love to see the expressions on their faces when I describe to them how I never have to worry about donning scrubs, bad weather, not seeing my family for 12-14 hours per day, or traffic congestion, (unless you count the dogs in the hallway outside my office). I can proudly say I am a Telephone Triage Nurse.

I know from what you have just read, you are thinking, how hard can that be? How can you be a nurse, and actually like your job, or even yet, LOVE it? Some days, after a long shift, I am more tired than when I worked 12 hours on a telemetry floor, but it is more rewarding and enjoyable than I could ever have imagined nursing to be. Sure, when I was a new graduate, I hit the Med-Surg floor with rose colored glasses ready to save the world. It did not take too long before I realized the only thing I was going to be able to save was my sanity.

Nursing has always been a demanding job, and in 2010, the statistics don’t look any better than they ever have for nurses. With the economy in poor shape, tighter restraints have been placed on hospital budgets. This has lead to hiring freezes, holds on raises, and lay-offs. Ultimately, the result is increased patient load for the nurse on the floor. Acuity levels are higher, and nurses are finding themselves filling multiple roles. At the end of the day, you are left saying, “Is this what I want to spend the rest of my career doing?”

After struggling for years in one specialty area or another, I begin to think that there had to be something else better out there. Something that was enjoyable, that allowed me to spend time at home, and yet, the pay was still comparable to what I was earning in a hospital. I earnestly began my search for a new me. Hey let’s face it, nursing is a big part of who we are as individuals! Thus, began my life as a Telephone Triage Nurse.

My work day typically begins about 5:00 in the evening, and ends about 12am. On the weekends and holidays, the hours vary. They can run from 3 to 12 hour shifts that begin with logging onto websites, checking in with the other nurses to see if any updates, checking emails for changes, and getting my headset and phone ready to go. I take a quick peek at the screen, and see only 4 calls in there that need to be returned. Not a bad way to start a July day. If it were January, it would not be unusual to see up to 20 or more calls that all need to be returned within 30 minutes.

Triage nursing is not about chatting on the phone. It is about following specialized protocols for the age specific population that you are dealing with. In addition to protocols, there are office specific requirements, paging physicians, advising over the counter medications when appropriate, correct documentation, and sometimes, true emergencies. (Being computer savvy has its advantages. You could never keep up without at least some basic computer skills.) When you call that patient or parent back, you never know what you are going to find waiting on the other end of that line.

There are times that the job can be so demanding that you wonder if you are going to make it to the end of your shift without either dying from a splitting headache, dehydration because you have not had time to get a drink of water, or a ruptured bladder because there is no time for a bathroom break, but nothing is more heartwarming than to hear the comfort in the first time mom’s voice when she understands that she is not alone at 3am with a newborn who has a temperature of 103, or the reassured elderly gentleman that realizes he is going to be ok, even though he mixed up his medications.

Each call can be so different from the last, and the outcomes are sometimes never known. I have often sent patients who appeared to be critically ill to the ED, and wondered if they lived, or if the advice I gave might have played a part in saving their life. Sometimes, even curiosity plays a role. You can sometimes hang up from a complicated call questioning what is really wrong with that patient.

The one thing that I think I enjoy the most is providing excellent customer service whenever possible. That’s right. The patients are our customers, so are they physicians and for that matter. The other nurses are too. You see, I can’t do this job alone. It requires team participation, and each member of the team is my customer. Excellent customer service means returning calls in a timely manner, attempting to give the most appropriate advice, being respectful to the patient and attempting to meet their momentary needs, respect for the physicians in calling them only when necessary, and supporting my team members because they are there on the front lines with me, side by side. That is the sum of job satisfaction!
I am a telephone triage nurse,….and I LOVE MY JOB!