Thursday, February 21, 2019

What Makes a Successful Telephone Triage Nurse?
 I  recently started to ponder on our company and the nurses here who are successful, both present and past, and decided to share some insight on what has contributed to this success.
This is probably the first and one of the most important things that the telephone triage nurse should be adept at. Many of us grew up before there were computers or when computers were new on the scene. I will tell my age and say I remember typing classes in high school, not computer pals that they offer to preschoolers now.
However, 99% of what we do as telephone triage nurses is computer based. So, how do you become more efficient with computers? Take a computer class is one suggestion, but there are so many things on line you can do in your spare time as well. There are free typing tests you can do where you practice typing as you listen to recordings. Spend time just playing with your keyboard and learning what each key does or open a blank word document and practice hitting each tab to learn what its function is. If you get an error or cannot figure out how to fix something, google is an excellent teacher. There is a you tube video now for any computer issue you can think of. Trust me, I have looked. I remember when a clerical person at a former employer was once teaching me how to use a computer. Her words were “You are not going to blow it up. Whatever button you hit wrong, it is fixable.” Once I got over that fear, then I began to teach myself when issues came along.
Technology is just what we must be able to overcome in this position, and to be successful, you must motivate yourself to learn more to be able to do more.
The successful nurse must be able to translate bedside nursing and office competence over the phone easily. This is not a universal gift. For some nurses, it comes naturally, and others must work to improve it. It takes skill to be able to talk with callers with confidence, exhibit compassion, all while really listening to their concerns and giving them adequate advice and adhering to the protocols. This takes hours of practice and reviewing of the protocols. Teachers do not walk in to the classroom with little education and training, and effectively deliver their lesson plans to their students.
Webster’s Dictionary defines tactful as “careful not to upset or offend anyone”. This is just good customer service. The nurse that is successful in telephone triage thinks about their choice of words before they speak. After all, that is what we do, we spend a lot of time talking with callers who cannot see our faces or read our body language. We are speaking with callers who are anxious, upset or sick, and their emotions are running high. Even though we may not mean to be offensive or condescending to callers, one word can be easily taken out of context by them.
It has been said to put a mirror up where you can see your facial expressions while you are on the phone, and customers can hear you smile. Test it. It is true. Smiling on the phone radiates through to the callers.
Be open to your callers. Give them honest, sound advice, and if their symptoms are concerning, it is OK to say, “what you are saying concerns me, and this is why.”. You do not want to diagnose, but you want to educate them enough so that they will comply with the advice you are giving them. If you have a life experience that you are comfortable sharing with the caller, and you think would be beneficial to them, there is nothing wrong with sharing it. A mentor used the analogy of speaking with a young woman who had recently suffered a miscarriage and was not dealing well with it. The caller went on to tell the nurse that she could not know how she was feeling. However, this nurse could relate to her as she had experienced the same heart break in the past herself. The nurse shared her experience with this caller and was able to direct her to the appropriate next level as the caller could relate to her.
Webster’s defines triage as the sorting according to the urgency of their needs of care. Telephone triage nurses must think in this mindset to be successful. This environment is the same as a virtual emergency room. The queue is your patients waiting, and you must look at their complaints to see who needs to be “seen” first, and who can wait.
We have some of the most compassionate, caring nurses on the planet. However, compassion alone does not make a great triage nurse. Think back to your last experience in the ED, whether it before for you or a family member. A nurse performed a brief assessment of the complaint and decided how important it was for you to be taken to a room right away. This is what we, as telephone triage nurses should be doing consistently…scanning the queue with every call to see what calls look urgent and which ones can wait.
We know the plan in the ED is to get as many patients through in a day while providing efficient, safe and compassionate care. Our virtual ED here is the same. We want to provide callers with great care, but at the same time, we must be mindful of all the others waiting. So, efficiency is a priority to be successful.
So, what about those that come to the ED that really don’t need to be there, and should be calling their provider’s office the next am? We could compare that to callers that are requesting non-urgent medications, looking for test results, or just need advice on things that can be managed at home. Those take last priority, and if they came to ED, they would be advised to call their provider the next morning. That is how they should be handled here, unless they get angry or there are different directions on the profile. Many callers need to be trained that unless it is urgent, they need to be calling during office hours.
With training the caller, there comes responsibility. Back to the ED scenario, if you needed an RX sent to a pharmacy, would the ED nurse look up hours of pharmacies nearest your home for you? No. They would ask you what pharmacy, and that would be it. When you leave the ED, they give you a list of instructions to follow and what to do if….  They do not call you later to check on you and to see if you have following their instructions. They place that responsibility on you.  An efficient telephone triage nurse does the same, educates the caller and empowers them with the knowledge they need. While it would be nice to follow up with callers, our patients in our virtual ED would just not get moved through so more patients can be “seen”, if that were the case.
Telephone triage is essentially practicing emergency room nursing over the phone and requires skill. Not just with patient assessment, but it requires multitasking, shifting perspectives, being confident in the decisions you make and the advice you give, all while being able to quickly move callers through the virtual ED so you can provide the same care to the next patient that needs you.


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