Succeeding in a Career as a Telehealth Nurse

Taylor Leamey

Feature Writer

Reviews.com

Telehealth Nursing: An Essential in Our Hyperconnected World

The telehealth nursing industry is a booming job market that allows for flexibility and virtual collaboration between health professionals. Remote nurses are able to treat patients and monitor their condition and progress with the help of audio and visual accessories, computers, and telephones. They are especially adept in cases of pre- or post-surgery, monitoring disease management, and care coordination. This comprehensive guide provides insight into what it takes to be a remote telehealth nurse and how to be successful in the field. 

In this article

• Considerations Before Becoming a Remote Nurse
• How To Land the Job
• Expert FAQ
• Creating a Successful Workspace

Remote telehealth vs. call center telehealth

No telehealth nurse looks the same. The flexibility of the field is one of the most notable advantages of the career path; telehealth nurses work in a number of environments: 

1. Live Videoconferencing (Synchronous): In this type of nursing there is a live, two-way interaction between nurse and patient with the use of audiovisual telecommunications technology.
2. Store-and-Forward (Asynchronous): As the name suggests, the health history is recorded and accessed by the provider through a communications system.
3. Remote Patient Monitoring (RPM): Communication technologies transmit personal health and medical data from the individual in one location to the nurse, who uses the information collection to assess care and related support. 
4. Mobile Health (mHealth): Health care practices and education supported by any mobile communication device (cellphones, tablets, PDAs). Can include everything from targeted text messages to wide-scale alerts.

Benefits and Considerations Before Becoming a Remote Nurse

Efficiency and affordability for patients

As reported by the American Hospital Association, 76% of United States hospitals use telehealth practices because of the perks it can provide. Meeting with a remote nurse is great for non-emergency visits such as minor injuries, primary care, and remote patient monitoring, and thus telehealth practices save people money and the hours they would have spent in the waiting room. The University of California Davis determined, by examining 18 years of their own clinical records, that telemedicine visits ultimately saved patients nine years in travel time and $3 million in costs. An additional benefit of telehealth practices is their ability to broaden the scope of the health care system and increase options for rural patients (provided their internet connection is strong).

Flexibility and freedom for nurses

The societal benefits of telehealth nursing are obvious, but what can it do for you? Simply put: mitigate stress. You aren’t juggling patients, handling bodily fluids, and running from one patient to the other. But beyond that, nurses find that they can focus on patient care and leave the red tape of traditional facilities behind. According to a 2017 survey of registered nurses, 44% of nurses say they often do not have the time they need to spend time with each of their patients. In addition, 55% of nurses stated they suspect that the physically demanding and sometimes emotionally draining nature of nursing is affecting their health. Telehealth practices are a unique avenue that offer nurses another way to do what they love without sacrificing the value they put on their patients or themselves. 

Challenges and Benefits of Remote Nursing

Telehealth nurses still experience all the typical challenges remote workers face: problems with focusing, detaching yourself from the job, and the feeling of being disconnected from coworkers. An additional perceived long-term barrier to consider is the opportunities for advancement. This is not to say there are none, but remote nurses are sometimes required to be more proactive and seek out advancement more often than traditional workers. Luckily, telehealth nurses are not limited to one small area of nursing and can transition between sectors and advance in leadership roles, albeit in a process that differs slightly from traditional hiring.

Challenges Remote Nurses May Face

Pros	Cons
Freedom and lifestyle flexibility	Feelings of isolation
Less stressful than traditional options	Opportunities for advancement may seem tricky
Widens the scope of health care, particularly in remote areas	Potential for long hours and odd shifts
Ability to focus on personalized patient care	Must depend on the patients’ description of symptoms
Increased patient satisfaction	May need to mitigate 911-like panic/helplessness of someone calling in with an emergency
No exposure to blood or bodily fluids	Call centers are a common work environment, which may not be ideal for every nurse
No contact with needles or injections	Primarily sitting or standing in one place for long hours
Low physical demand

Who Can Become a Remote Nurse?

If you are interested in pursuing a career in telehealth, you must either have a licensed practical nurse degree or a registered nurse degree with a nursing license. Most companies also like to see you have a minimum of one to two years of on-site nurse experience.

Remote Nursing Opportunities

Title Credentials National Pay Average Additional Details Expected Growth (2016-2026) Remote Triage Nurses Minimum bachelor’s of science in nursing (BSN). Also required to pass the National Licensure Examination For Registration Nurses. Average: $70,302 Range: $64,149 - $ 79,505 Remote triage nurses are required to determine the level and type of care a patient needs. They must be able to decide purely by speaking over the phone. 15% RN Case Managers Typically a minimum of a bachelor’s of science in nursing (BSN) is required, while there are some with an associate degree in nursing (ADN). This is rare. In most cases, RN case managers hold a master’s of science in nursing (MSN). Having a case management Average: $64,000 Lowest 10%: $ 47,830 Highest 10%: $ 83,870 RN case managers are registered nurses who assess, plan, implement, and evaluate patient care. Unlike other nurses, case managers also focus on being fiscally responsible. 15% Nurse Auditors Minimum bachelor’s of science in nursing (BSN). Average: $72,885 Lowest 10%: $61,000 Highest 10%: $86,000 Nurse auditors run reports to locate and resolve mistakes or errors on various medical accounts 15% Remote Nursing Instructor Must have a bachelor’s of science in nursing and a valid nursing license. Several years of work experience is required. Average: $61,322 Range: $45,000 - $82,000 Nursing instructors are responsible for educating aspiring nurses about patient care, and expected to design a curriculum and lectures. 19% Quality Assurance Nurse Associate’s or bachelor’s degree in nursing. Average: $71,730 QA nurses review hospital nursing practices and documentation, and implement change as needed. 12% Legal Nurse Consultant Bachelor’s of science in nursing (BSN). Additional LNC training. Average: $70,000 Legal Nurse Consultants work with law professionals to assist on medical malpractice cases, insurance fraud cases, worker’s compensation, etc. 15% Medical Writer Bachelor’s or Master’s degree in Journalism or English. Average: $63,100 Medical writers have two paths available: scientific medical writing or marketing medical writing.
11%

How to Land the Job

Proving remote-worthiness

As with any remote job, employers like to see examples of past remote experience on your resume, so regardless of what field your remote work was in, be sure to highlight it appropriately. Any level of remote working experience is worth mentioning, even if you only sporadically worked at home when you had a doctor’s appointment or were out sick. Don’t panic if you haven’t had a remote job – plenty of telehealth nurses didn’t before they transitioned into their current roles. Having tangible nursing experience is the real key to landing a remote job in the field, which is why we spoke to the experts, remote nurses, and others with expertise in the field.

Any level of remote working experience is worth mentioning.

Brenda Glover, a telephone triage nurse for Nurse Telephone Triage Service, spoke about realizing her need to work from home and taking to the internet to research her options. She acknowledged that some companies do like to see remote nursing experience, but it isn’t the end-all-be-all. What companies deem most important, she said, is being a good nurse. “A well-rounded nurse who has a varied background usually does well. Because not only are you relying on protocols, but you’re relying on personal experiences.” 

Nurses find that they can focus on patient care and leave the red tape of traditional facilities behind.

Brenda also sites being technology-savvy as one of the most important skills. She describes telephone triage nursing as “a fast-paced position that requires a lot of being able to multitask and listening to somebody talk and being able to move from one screen to the other.” Telehealth nurses must be critical thinkers who are practiced in how to press for information from patients about signs and symptoms they may be experiencing. Thinking on the fly and prioritizing patient needs by the level of urgency is an everyday staple in a remote nurse’s life. 

Essential skills for remote nurses:

• A passion for nursing and solid clinical knowledge
• Strong assessment and communication skills
• Ability to easily adapt to new technology
• Patience to troubleshoot issues that arise
• Ability to multitask on a dual-screen computer and navigate various systems
• Typing while speaking with patients
• Ability to convey empathy and understanding using tone of voice

Ask the Experts: FAQ

How do you find a remote nursing job?

There are numerous online resources that connect nurses with remote options. There are companies all across the country that hire remote nurses, some exclusively. 

1. Aetna – A highly recognized health care insurance company, Aetna hires for a variety of remote workers, including RN case managers and nurse consultants.
2. DaVita – Focused on kidney care, DaVita hires remote case managers.
3. Humana– One of the most well-known health care companies, Humana hires for care managers, telephonic CCR, case managers, and clinical advisors.
4. Anthem – A health benefits company, Anthem offers a variety of teleworking nursing positions.
5. Cigna – An insurance company, Cigna hires registered nurses as consultants, writers, educators, and clinical care managers.
6. CareNet – Providing 24/7 health care, CareNet frequently offers RN positions. 
7. UnitedHealth Group – UnitedHealth Group consistently posts positions for registered nurses all across the country.
8. Healthfirst – Based in New York, Healthfirst offers both home office and onsite nursing positions.
9. FoneMed – A telecommunications provider, FoneMed hires across North America.
10. Nurse Telephone Triage Service – An RN-owned company, Nurse Telephone Triage 

What do you need to become a telehealth nurse?

First and foremost, becoming a remote or telehealth nurse requires both a nursing degree and a nursing license. Liz Greenberg, PhD, RN-BC, C-TNP, CNE, an associate clinical professor at Northern Arizona University and a past president of the American Academy of Ambulatory Care Nursing (AAACN), described finding her own passion for telehealth nursing through her experience in an after-hours pediatric clinic, in which she was charged with answering calls from patients parents and caregivers. She cites a passion for nursing and a respect for patients as the basis for every nurse’s journey into telehealth and encourages them to gain “an in-depth understanding of how to assess and communicate solely via technology.”  

What is the transition from traditional nursing to telehealth nursing like?

When asked to reflect on her transition to remote triage nursing, Brenda Glover described a process of trial and error with a lot of patience sprinkled in. When she started in the industry, there was very little computer use, everything was notated in charts. She went on to say that, “It has been challenging, but it’s been rewarding. Because I now feel very secure in the role and I feel like I could troubleshoot just about anything.”

Dr. Greenberg’s response was in a similar vein. Describing it as difficult at first, she said she got to a point where technology became a tool that she needed to connect and provide care to her patients. 

Does the company provide the hardware used?

 Dr. Greenberg said while companies usually provide the equipment, nurses are able to negotiate the use of their own equipment if they choose, provided it meets all the requirements. The equipment and services provided by the employer are completely dependent on the company you work for. While some companies may cover your computer and devices, others may require a nurse who works from home to not only provide their own computer and phone, but internet service too. On the bright side, if you do end up having to provide your own equipment, you can claim it on your taxes. You can even deduct some — maybe all — of the expenses of your internet connection as a part of your home office expenses.

“My personal belief is that the human connection provided by nurses via remote communication is highly valued by individuals who have health concerns and or questions.”

– Liz Greenberg, PhD, RN-BC, C-TNP, CNE

What does someone considering telehealth nursing need to know?

For Dr. Greenberg, “I think the biggest thing to know is that this is often an independent practice – one that relies on assessment and critical thinking and the breadth and depth of both the nurse’s education and experience (in life and in health care). Depending on your practice (e.g., triage, advice, remote monitoring, care coordination) your decisions may be guided by standard orders, decision support tools, or care guidelines but you must be comfortable and confident when those guidelines need to be overruled for safety.”

Dr. Greenberg also spoke to the interdisciplinary communication that is required for some areas of telehealth nursing. Appreciating and understanding what other team members bring to the table is just another facet of communication for a telehealth nurse.

Creating a Successful Workspace

Safe, secure, reliable internet: key for remote nurses

The internet is your lifeline. Not only does it allow you to do your job, but having a seamless internet experience presents professionalism and ultimately may make or break your ability to advance. If you hope to be a successful remote nurse, having a fast and reliable internet is a must. Without a strong internet and phone connection, remote nurses cannot meet the basic requirements of their jobs.

The Health Insurance Portability and Accountability Act (HIPAA) requires that all technology used during patient care have compliant software for encryption and privacy, to protect electronic medical records and patient information. Mobile devices and tablets that are used in medical care are also required to have a secure configuration that will protect data. Patient information should never be accessed from an unsecure device. The use of Virtual Private Networks (VPNs) in health care allows patients and health care professions to remotely access to health information safely. A VPN is an extension of a private network that can be accessed over a public internet connection. Using authentication steps and encryption mechanisms, VPNs add another level of security and privacy to a nurse’s public network. 

Internet type	Pros	Cons	Which is best for telehealth nurses?
Fiber Optic	Extremely fast and reliable internet connection with no data caps. Great for hosting servers and complex cloud-based systems.	Very limited availability, mainly found in cities. Higher cost than other options.	Best
Cable	High speed and very reliable. Internet not dependent on cable, but uses the same wiring.	Neighborhoods share bandwidth, which may lead to connection issues during busy times. Cheaper than most options.	Better
DSL (Digital Subscriber Line	Widely available from multiple providers. Dedicated bandwidth that is not shared.	Low speed with performance based on proximity to provider. One of the cheaper options.	Good

Testing your internet 

Telehealth nursing is dependent on technology. Testing your internet speed will tell you if your connection is able to support and sustain that type of work. Thankfully, it’s easy to test for both urban and rural areas. When testing your internet speed, you’re assessing the latency, download speed, and upload speed performance. But before you start, there are some steps you need to take to ensure you get the most accurate reading. First, always restart your computer to shut down any residual apps running in the background that may slow down your latency rate. Then, disconnect from any virtual private network (VPN). VPNs or data-saving apps will slow down your connection and give you an inaccurate reading on the test. It’s important to test your connection more than once so you get the best idea of your status. 

• Speedtest.net – One of the most established and popular options. It allows users to keep a record of previous tests for comparison. 
• Fast.com – Operated by Netflix, fast.com offers an ad-free interface.
• Xfinity Speed Test – User-friendly interface that isn’t cluttered with ads or pop-ups. 

What to do if you’re experiencing internet issues 

1. Reset your modem and router. 
2. Assess the placement of your router. The farther away you are from your router, the weaker your signal will be. Being as close to your router as possible will result in the best wifi connection.
3. Use a mobile hotspot. Acting in lieu of a modem or router, a hotspot distributes internet connection to your devices.
4. Use a wifi extender. Wifi extenders plug into your router and are designed to repeat your wireless signal and expand its coverage.
5. Still having connectivity issues? This step-by-step guide walks you through exactly how to troubleshoot your connection.

According to Brenda, her company in particular requires that their nurses have a back-up plan for if they are having internet issues. In her case, nurses are required to go to another location with reliable connection to work until their personal connection is up and running again.

Addressing your phone service needs

Depending on the remote nursing role, a landline telephone can be used exclusively to speak with patients or in conjunction with the internet and other telecommunications tools. While computers, custom software and audio/video feeds are necessary for a remote nurse to have, some patients are limited to only their phones. Some employers will set you up with phone service through their systems, which will likely be cloud-based. If they don’t provide a phone service, then consider shopping around yourself or using a cloud-based service so your phone is as reliable as your internet. 

Setting Yourself Up for Success

Nurture a healthy avenue of communication with coworkers

To be a successful remote worker, creating an open line of communication is essential. Many remote workers can attest to the feelings of isolation and being left out of things that go on in the office. The walks to get coffee and the convenience of tapping your coworker on the shoulder with a question are often taken for granted. Build connections with coworkers and regularly plan meetings to chats with them. Communicating as much as possible is key to still feel like part of the team. Organizations such as the American Academy of Ambulatory Care Nursing and the American Telemedicine Association are focused on advancing the telehealth field and providing support for those in it. Creating connections through these organizations is another way to feel involved. 

Set a schedule and stick to it

Patient and self-care are tightly intertwined for telehealth nurses. Self-care takes many forms: eating and exercising, social interaction, and routine. Without the need to begrudgingly sit in traffic your mornings are wide open, and there’s a lot of ways to spend your time, which can be a problem for some people. That’s why it’s important to set a schedule for yourself, regardless if you work day or night. Create a routine and stick to it, or at least as well as you can if you often work different shifts. Establishing a time for meals, breaks, and physical fitness is not only great for your productivity, but for your sanity too. Making time for exercise can sometimes feel like a hurdle but it’s especially important for remote workers.

Quick Self-Care Tips for Remote Nurses

• Stream your workout classes. A great option for nurses who work irregular or odd hours. 
• Find a network of friends who work remote and set up a weekly happy hour, lunch or coffee date to schedule face-to-face interaction. 
• When your shift is over, get out of the house! A change of scenery helps you mentally put away work so you can enjoy your personal time. 
• Have a separate workspace in your home. 

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.

Technology

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.

Translate

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.

Tact

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.

Truthful

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.

Triage

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.

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.

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.

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.