Editor’s Letter
Summer is here and the time is right to travel.
Enjoy, and see you next month!
Trying Telephone Triage
By Norma Walsh
Any nurse who’s worked in an urgent care setting will tell you that it is invariably the most severely ill/injured patients who say, “I wasn’t even sure I should come in for this,” (and “this” could be anything from kidney stones to an MI to a deep puncture wound) and are the most apologetic about “taking up your time” and “being a nuisance,” while those who present with hangnails and cold sores are the most apt to complain, loudly and vehemently, about long wait times and not getting the brand-name antibiotic they are sure they need. What if you, as a nurse, could help ensure that people who need emergency care seek it, and help those not requiring immediate treatment understand their conditions and find appropriate care in the near future? Perhaps telephone triage nursing is a career option for you.
Telephone triage nurses are employed by health insurers, HMOs, physician’s offices and hospitals as a front line resource for patients who have questions about changes in their health and what kind of treatment they should pursue. Telephone triage nursing is different than health advice lines offered by insurance companies, health care facilities and municipalities, which exist to provide answers to general medical questions. Telephone triage aims to advise patients regarding appropriate treatments for their current symptoms and decrease the number of unnecessary office and emergency room visits.
Telephone triage services rose to prominence in the U.S. during the mid-1990s in response to the overwhelming numbers of non-urgent cases presenting at emergency departments. The idea was adopted by physician’s offices as a way of advising patients who called with concerns during or outside of office hours where, when or if to seek medical attention. Because of the special challenges involved in telephone triage nursing, it takes a certain kind of nurse to enjoy the job and meet its goals.
Obviously, evaluating a patient over the phone is a different experience than triaging a patient in the ED. With no physical assessment and lacking the non-verbal cues and diagnostic equipment that help a nurse understand a patient’s complaint, the telephone triage nurse must rely on excellent communication and interpersonal skills. It requires an in-depth knowledge of disease processes applied in conjunction with critical thinking and judgment, although the telephone triage nurse does not provide a diagnosis. The phone triage nurse assesses the information given by the patient, asks questions and guides the patient to the appropriate care.
Telephone triage is provided by RNs, generally those with extensive hands-on triage experience or who have taken classes that specifically teach pone triage skills and protocol. Ongoing education is usually part of the job. Performing telephone triage nursing has unique pros and cons. On the plus side, nurses deal with a varied caseload, work regular hours, may even be able to work from home rather than at a call center or medical facility and the job itself is not physically demanding – there is no heavy lifting or clean-up. Negative aspects of telephone triage include the lack of personal contact with patients, no follow-up with patients, no real interaction with colleagues, heavy computer/paperwork load and a sense of isolation or disconnect. One must have the proper skills, mindset and personality to succeed and thrive as a telephone triage nurse.
Certification is not usually required for working as a telephone triage nurse. However, many employers see this as a reflection of competency and professionalism that then increases the appeal of a job candidate. The National Certification Corporation now offers certification in Telephone Triage. As with most other certifications, there are certain eligibility requirements, such as current licensure, 2000 hours of specialty experience and recent employment in the specialty if applicable
The Emergency Nurses’ Association (ENA) notes in their Position on Telephone Advice that “as health care changes in this country, the demand for telephone assistance is climbing.” It advises, however, against nurses performing such functions without an established telephone triage program and without appropriate education, asserting that the consequences of nurses’ giving phone advice can be “devastating” in the absence of polices, protocols and documentation. There can be negative outcome for patients as well as risk to the facility and violation of state nurse practice acts if telephone triage services are improvised. ENA recognizes that “sophisticated telephone triage programs provide quality health care assessment opportunities that enhance and promote quality health care within the community,” but caution that proper expertise, training, documentation, continuing education and clearly defined policies and quality control standards are “essential in assuring that telephone triage does more good than harm.”
If you’re looking for a non-traditional way to use your nursing skills, telephone triage is an ideal example of a way nurses assist the community in a setting other than direct patient care or administration. Don’t be fooled into thinking that triage nursing is an undemanding job. On the contrary, a shift at the phone on a triage line can be more demanding than a day running up and down the medical/surgical floors. The major difference is that the delivery of top-notch nursing care must come without the advantage of seeing or touching the patient.
Nursing as a Second Career
By Norma Walsh
About five years ago, when she was in her early fifties, my friend Nancy made a decision that surprised her family and friends. She was going back to school. And she was going to become a nurse.
“A nurse?” more than a few people responded. “Why would you want to go through all that schooling? Start a whole new career at this age? Nursing’s not easy, you know.”
“I had been the primary caregiver for both my aunt and one of my very close friends during their final months,” Nancy told me. “And I found that I was a natural at it. Being able to do what I did for them showed me that I had a calling for nursing, even though I’d been doing something else for almost 30 years.”
That “something else” was working as a top-level executive assistant. Nancy had been the right-hand-woman to some of the most prominent corporate leaders at some of the largest firms in her city, in fields ranging from commercial real estate to publishing. Could she walk away from the world of designer suits and catered lunch meetings into the completely different world of scrubs and sandwiches from the cafeteria? She could, she did, and she’s never been happier. Nancy found that she was in good company, and plenty of it, as someone who chose a nursing career later in life.
Nancy, and others like her, knew going into it that beginning a nursing career is no small undertaking. As with any profession, good education, training and preparation for the realities of the job are essential to a candidate’s success, as is the support of one’s family and the ability to withstand the rigors of, perhaps, both attending school and working full time. Nurses, however, are in high demand – a situation that is expected to continue for decades – so colleges and employers are finding ways to make classes and clinical assignments a viable option for those coming to nursing as working adults. If you already have a Bachelor’s degree, many schools have accelerated nursing (BSN) programs that allow you to earn your degree more quickly. There are also part-time nursing programs that let you continue to work full time in your current position while studying. And many schools offer some of their courses online so you can work from home, a valued convenience for many older nursing students.
What does it take to become a nurse, at any age? Of course, the love of working with people is paramount. An aptitude for math and science, excellent communication skills and thriving on intensity and a fast-paced environment are critical as well. Older nursing students, however, are especially valued by nursing schools and prospective employers, because they bring energy and focus to their studies and work. This may stem from their having arrived in the field after years of considering it and finally having the chance to bring all that’s inside them out and applied to the real world, or, like Nancy, finding their way to nursing after a life-changing experience.
Why does nursing appeal to people who may have spent 20 or more years in non-medical fields? In addition to the feeling of personal satisfaction, people in their forties or fifties may be thinking about that not-as-far-away-as-it-seems retirement age, and are looking for a career with excellent earning potential and job security to carry them through the next 20 years or more. Nursing certainly fits the bill. With nursing salaries on the rise and many different opportunities for employment (visiting nurse, hospice, administration, phone triage, as well as traditional patient care roles in hospitals and offices), new nurses in their fifties will have options far beyond what would be open to them in other professions.
Women aren’t alone in finding their way to nursing careers after spending decades doing “something else.” Men are turning to nursing as a second career in ever-increasing (though still small) numbers. The often say they desired to pursue nursing as college students, but concerns about societal perceptions led them down other paths of study. Later in life, with more perspective and confidence and years of other kinds of experience under their belts, often seeking more meaningful work, they’re able to return to school and become nurses. Many men who come to nursing as a second career gravitate to intense specialties, like ICU and ER, while others apply their “old life” business skills to hospital administration or management.
A Vanderbilt University School of Nursing study cites concerns that the average age of working RNs increased by 4.5 years between 1983 and 1998. At present, the average age of working RNs is approximately 45.4 years, a number which has increased by more than 3.5 years since 2000. And the nursing shortage of the last ten years is expected to continue if less young students choose the field while large cohorts of RNs retire. Nancy, for one, is looking forward to spending the next fifteen years – “at least fifteen years,” she says – at the job she began after completing her degree and passing her boards: working in the post-anesthesia unit at the VA hospital in her city, where she did her first clinical rotation. “I love it here; I love the hospital, my patients and my co-workers,” she beams. “If I’d only known then what I know now.”
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