Calming Fears

With Enterovirus and Ebola being all over the news, it is natural for parents to worry when their child gets a fever or develops cold symptoms. Nurses may think the parent is over-reacting or being too anxious, but you have to put yourself in the layman's shoes. If you had no medical education, and all the information you had was what you heard on the news or searched on the internet, you would be scared too. I mean, after all, that is how the news gets ratings. They dramatize the story.
As a triage nurse, you have to be well educated on the current medical conditions that are making their way across the country and the globe. You cannot expect to educate callers and calm their fears if you are not sure about what you are educating them on, and you have to remember, they can tell in your voice if you are confident. Nothing increases a caller's anxiety more than to speak with a nurse who is hesitant in their advice. Most likely, they will get upset with you, and even demand to speak with a physician at that point.
How do you educate yourself so that you know you are giving the correct advice? Besides following the guidelines or protocols set into place by your organization, some reliable internet sites are good ways to keep abreast on current trends and treatments. One site to reference is the CDC, and another good pediatric reference site is the American Academy of Pediatrics. When doing internet searches, please keep in mind, you want to only use credible sites.
One last point is you must be comfortable in your role. That comfort will be transmitted to the caller, and they will likely follow the advice you give if they trust you and feel you are knowledgeable in your discussions.

Time Management

Let's face it. Anyone who has ever done telephone triage knows this can be the most mentally challenging job you might ever do. It is not an easy endeavor to take on. Not only do you have to be a quick thinker and problem solver, but you must be able to coordinate looking at protocols, listening to the caller, typing and thinking of a plan....all at the same time. To be efficient and proficient, you must be able to utilize your time wisely.
One of the things I try to instill in new nurses, is to be organized. You cannot be organized enough in this position. If someone were to look at my desk, they might not think that of me, but there is a method to my madness. I know where everything is, and I can access it in a minute. I also have notes stuck everywhere as reminders and quick access if I should need it. Not everyone would be able to function like this, but it works for me. That is what matters. You have to set up your own system.
Another thing is, when you are actually taking calls, you have to be aware of the length of time you are on the call. I am not saying you should rush through it and miss important assessment information, but you should be taking control of the call. If you allow the caller control from the beginning, you may never return. We all know that many callers want to tell you everything about their life, and much of what they want to talk about is not pertinent to the call. If you begin the call with asking assessment questions, such as "So I see you are calling because John has a fever. When did this fever start?", it allows you to get the information you need much more quickly and keeps the caller focused. Saying, "What can I help you with?" is a very broad question and makes it harder to keep the call under control.
Another thing I find nurses do is skip around. It works much better to gather all of the assessment information first, and then give the advice. If you stop in the middle of the call to give fever advice and then go on to assess cold symptoms and give advice for that, it is more time consuming. Also, how can you give complete advice if you don't have the whole picture? After all, we know that one symptom can influence another.
Finally, I encourage nurses to think outside the box. You should never be so focused on protocols that you miss the big picture, and don't get yourself caught up in little unnecessary details. For instance, I have seen calls regarding immunization reactions where most of the child's arm is very red and swollen and the nurse gets caught up in what kind of immunization they had. That is great if the parent knows, but the ultimate outcome is they need to seen asap to have it evaluated. Give them the necessary advice, and move on. There are other calls waiting.
You cannot be a successful telephone triage nurse overnight. It takes time to learn and change the way you think. It is not like any other area of nursing you have experienced.

Smile. Your callers will know it.

Every since I began doing triage, I have heard, "Smile while you are talking. Your callers will know you are". When I first heard that, I thought it sounded silly, but have since come to realize it is true. If you are smiling, people know it. According to an article on Discovery, human beings can differentiate vocal intonation not only between a smile and a non-smile but among different types of smile. “Smiling affects how we speak, to the point that listeners can actually identify the type of smile based on sound alone…”
Our callers need to know that they are being heard, appreciated, and supported. I cannot think of a better way than adding smiling to our phone etiquette. If the caller feels that they had a good interaction with you, then they are more likely to listen to your advice and follow it. In return, they will give positive feedback to their physician's office and everyone benefits.
So, the next time you pick up that phone, ask yourself, "Are you smiling?"

Our Callers Make Us Who We Are

So many times, we hear that the people we surround ourselves with is what makes us who we are. In telephone triage, our callers help to mold us into the triage nurses we become. When you are a telephone triage nurse, it is as if you have been invited into the callers home and have been allowed to enter their personal space. We often get to witness the raw emotion that we otherwise would not experience in any other specialty area. In return, sometimes, there is that one caller you just cannot get off your mind, because somewhere, they touched you. They brought you a dose of reality. They reminded you that people's lives are not as perfect as they sometimes seem, and they give you a sense of appreciation for the little problems you think you have. You realize that there are patients who are really hurting. and they need us.
One such caller, that I often think of from time to time, and wonder how her situation turned out and how she is today, is a young mother who was dealing with a young child with depression. She started the call by telling me her nine year old son had been asking her what depression and suicide meant. He told her he was thinking about it after seeing a TV commercial for anti-depressants. She had assumed she had explained it to him and everything was ok, until days later, he confessed to her, with tears in his eyes, that he had voices in his head telling him to hurt himself but he did not want to. He was crying out to her for help.
I started thinking that maybe the child's imagination had gotten the best of him after seeing the commercials, and maybe the mom was over anxious. However, my heart sank when she told me through her tears that the child's father had committed suicide when he was an infant, and she had never told her son how his father died. At that moment, I wanted to reach through the phone line and just give her the hug she so very much needed.
This mom knew what she was facing, and she knew exactly what she needed to do. She just needed someone to give her permission to do it. After advising her to take her child to the ED for an evaluation, she voiced to me that she knew that was the next step. She just needed someone to listen and validate her as a mother. My heart was breaking for her. The call ended after she was able to gain some composure, and she thanked me for listening.
I never knew that outcome of that call, and I often wonder how she is. When I do, I say prayers of thanks for the little things I call problems, and I regain perspective. I hug my kids a little closer; tell my husband I love him more often; spend an extra minute with my dog; and appreciate the little things we take for granted.
Yes, my callers make me who I am, and they sometimes teach me to be a better person.

Happy Nurse's Week!

In thinking about National Nurse's Week, next week, I have been reflecting back to Florence Nightingale and how the nursing profession evolved. Boy, has it ever changed in just the last 20 years!
When I graduated nursing school, we still had the caps and white uniforms, and hardly a school issues caps anymore. I understand the whole theory about being more modern, and even the infection control risks with caps. However, to be given those stripes to add to those caps meant something, and we wore them with pride, and do you remember the first time you signed your name with R.N. behind it? I do, and the sense of accomplishment was like no other.
Even though nursing schools and facilities do not adhere to the traditional uniforms anymore, we as nurses, should never falter in taking our profession just as seriously. The most recent gallop polls still rank nursing as the most trusted profession based on honesty and ethical standards. Wow, that's alot to live up to!
Here at NTTS, we salute our nurses, and we thank them for keeping both company and professional nursing standards. Our nurses are what enables us to continue to provide quality patient care. We also never cease to salute our first nursing leader.....

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.

Thank you Florence Nightingale for all you did to help us become a profession to be proud of, and thank you NTTS nurses for the quality care you provide every day!
Happy Nurses Week!

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.