Overcoming The Challenges of a Virtual Environment

To describe managing nurses in a virtual call center as “challenging”, would be the best summation I can think of. Nurses, as any other employee, have their own personalities and gifts they bring to the workplace and it can be difficult to really get to know your staff members when you are in a virtual office environment. However, we have done quite well in creating an environment where our nurses can feel valued, as well as feel that we recognize them as individuals.

Our staff connects via monthly newsletters, birthday recognition, and peer nominated awards. These are just a few of the ways we relate to each other, even though many are miles apart. Emails are a main source of communication, as well as texting, and social networking sites like Facebook or Linked In. We also hold quarterly virtual staff meetings to communicate any updates and to give staff members an opportunity to discuss any issues.

For anyone that feels working in a virtual office environment would be isolating, that would only be if you allow it. Technology can be used to accomplish virtually anything. It just takes a little effort, and it is amazing the friends and “family” you can make right from your own home office.

Managing Difficult Callers

Happy New Year to all. As I sit here, thinking about how to make a difference in the New Year, and how to motivate others do the same, the first thing that comes to mind is managing difficult callers. I am sure that anyone who has done triage for very long can think of at least one instance of dealing with a difficult person.
I personally feel these callers do not intentionally set out to be rude and to make our lives hard. By the time they have reached us, most of the time, there has been a series of events that have led to frustration, and the caller just wants to know they are being heard. It does nothing but increase their frustration if the nurse does not take a moment to really listen to their concerns. When I get one of these callers, I stop, take a deep breath and give them a moment just to be heard. The next step that I have found to be effective is to apologize. Sure, I have nothing to apologize for personally, but I want the caller to know that I am sorry they have not been treated the way they feel they should have. If I can then fix the issue for them, I do. If I cannot, I explain to them why I can’t, and at the same time, offer them some advice on how they can approach the issue for the best resolution possible. All the while, I assure them that their concerns will be documented and encourage them to follow up with their physician’s office the next business day.
One of the worst things the nurse can do is say, “I know how you feel”. Unless you have walked in that person’s shoes, you could not possibly know how they feel. We also need to remember, that even though we may have experienced similar circumstances, we are not the caller, and everyone handles every situation different. Sharing personal information about having gone through similar situations can sometimes be appropriate if you think it will reassure that caller and make them not feel so isolated, but never give them advice that would contradict protocols or procedures.Also, never give advice that does not show cohesiveness with their physician's office.
Dealing with problem callers is very draining mentally and emotionally, but after all, when we took the Florence Nightingale pledge as nurses, we promised to do our best to care for our patients. Even though no one likes these kinds of calls, we need to stop and remember these are people with real needs, or they would not be calling. What seems minor to us, could be a mountain to them.
Wishing everyone a healthy, blessed 2014. Make it year to make a difference to someone.

Review for the Flu Season Ahead

With the upcoming flu season just around the corner, triage nurses everywhere are preparing for the busy season ahead. Most people overcome the flu with little complications, but we must keep in mind those that are at higher risk and what we, as nurses, can do to recognize signs of complications and give the most appropriate advice to decrease the risk to the patient.

Those that are at highest risk include:

*Children under age 2

*Adults over age 65

*Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus) or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)

* Persons with immunosuppression, including that caused by medications or by HIV infection

* Women who are pregnant or postpartum (within 2 weeks after delivery)

*Persons aged younger than 19 years who are receiving long-term aspirin therapy

*American Indians/Alaska Natives

* Persons who are morbidly obese (i.e., BMI is 40 or greater); and

* Residents of nursing homes and other chronic-care facilities.

Calls, where the patient falls into one of the above categories, and they are exhibiting flu like symptoms should be high priority, and would be candidates for anti-viral medications. For these medications to be most effective, they should be started less than 2 days of onset of flu symptoms. Patients should be encouraged to consult their physician’s office by the next day to discuss this treatment. However, if the office is closed, the nurse may often find themselves contacting the physician on the patient’s behalf to get treatment started immediately.

In addition to giving the usual advice for fevers, hydration, and minor upper respiratory symptoms, we should be educating callers on warning signs or red flags that could indicate more severe symptoms that they should seek immediate medical attention for. These symptoms would include very high fevers, fevers that are not responding to medications, increased weakness and lethargy, decreased levels of responsiveness or confusion, signs of dehydration, and labored breathing. I cannot stress education enough. If the caller and/or patient are armed with the necessary information they need, they are more likely to recognize early warning signs and seek further treatment more readily, thereby decreasing mortality and morbidity rates.

The Teaching Role

            Nurses take what is foreign to the patient, put into perspective, and make it understandable and less frightening (Benner, 2001). This sums up ninety percent of my job, as a telephone triage nurse, on any given day. Patients call about various symptoms and illnesses, and are looking for explanation and guidance on what they need to do. Often they are worried, frightened, or just plain lost in the huge medical care system. Many of the calls we get are an acute crisis, but sometimes, they call because they want a nurse to explain to them what the doctor did not.

The socioeconomic class of callers varies. Many are college graduates and understand basic medical terms, and others never finished high school. These callers have to be taught in basic terms that a seventh-grader would comprehend. The nurse has to make a basic assessment of the caller’s understanding in the first minute or two of the call.

In determining a critical situation in my own practice, I cannot think of a particular one, but there are a particular group of callers that I enjoy teaching. Those are parents of young children with croup. These parents call alarmed and worried, because their child is experiencing respiratory difficulties. They don’t understand why. Often, they are walking out the door to the ED when the call is placed. It is a job well done when you can talk them off the ledge, and help them to understand croup is a common childhood illness, and most times, the child does well with simple homecare advice.

Callers/patients need and want to know why you are giving the education that you are (Benner, 2001). They are much more likely to comply with instructions if they understand the rationale behind it. Our role, as a teacher, is to help them understand their situation. That is exactly how I teach croup parents. I help them understand why their child is making this terrible noise, symptoms of severe distress, and treatment they can provide at home to give symptom relief. I then follow-up with them about thirty minutes later to assess for improvement, and give other instructions if need be. The parents are appreciative of the care and education, and it gives them a sense of control over the situation, to know they can manage the situation. They also know that they are not alone, and they can pick up the phone and call for support at any time.

Reference

Benner, P. (2001). From novice to expert: excellence and power in clinical nursing practice (Commemorative Ed.) Upper Saddle River, N.J.: Prentice-Hall, Inc.