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.
