On call: Round-the-clock nurses deliver advice over the phone
By Allison Ellis / Special to NWjobs
Seattle mother of two Mary Ruhlman was gardening in her yard one day when her son sprayed his younger sister in the face with a bottle of weed killer. “I panicked,” she says, and quickly called EvergreenHealth’s 24-hour consulting nurse line.
“The person on the phone was so calm and reassuring,” Ruhlman says. “She told me how to rinse out the affected area, and then called me back the next day to follow up. I really appreciated that.”
Registered nurses who staff 24-hour telephone services or call centers are commonly known as telephone triage nurses or consulting nurses. Telehealth Nursing Practice (TNP) is recognized as a subspecialty under the American Academy of Ambulatory Care Nursing, and nationally recognized evidence-based triage guidelines serve as the backbone of most call centers.
“We assess callers based on their symptoms and direct patients appropriately to the right care at the right place at the right time,” says Vickie Ravenscroft, director of EvergreenHealth’s Healthline and Nurse Navigator. “Our role is not to diagnose.”
National Nurses Week
When: May 6–12, 2014
2014 theme: Nurses: Leading the Way
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Lori Lee, who was an EvergreenHealth oncology nurse before switching to an RN staff position with the 24-hour Healthline, says the best aspect of the job is the variety. “I get to talk to people all across the life spectrum — everyone from the person who calls and says, ‘I just found out I’m pregnant’ to hospice patients,” she says.
Going from a job where you see patients every day in a hospital or clinical setting to not seeing them at all can be a major adjustment, explains Lee: “In person, we can see their color and their expression, but on the phone we have to ask detailed questions: Where are you hurting the most? How do you feel when you stand up? Can you walk normally? Does your skin feel hot? Are you chilled?”
Telephone triage nurses also ask callers about medications and medical history in helping to determine the appropriate level of care, and Healthline nurses are conservative in dispensing advice.
“We can only gather as much information as a patient is willing to share,” says Ravenscroft. “If they tell us that their pain is a 10, but they are watching TV and eating popcorn, we have no way of knowing that,” she says. “We can’t do vitals over the phone.”
Extensive training, quick thinking, multitasking, fast typing, intuition and collaboration are all key components of the job, requiring a nurse to talk, listen, look at a computer and type — often all at the same time. “It can be overwhelming,” says Ravenscroft.
For that reason, Healthline nurses are typically required to have a minimum of five years of nursing experience, a master’s degree in nursing, or certification in Telephone Nursing Practice or Ambulatory Care Nursing. The right personality traits are key as well, Ravenscroft says: “They need to be comfortable making assessments, trusting the protocol and thinking on the fly.”
Evergreen’s Healthline is a levy-funded service, reaching the greater King County/Puget Sound area, and is free to the public. With a staff of 19 nurses who work six- or 10-hour shifts, the Healthline also contracts with area hospitals and other health providers, including Seattle-based Virginia Mason.
Group Health Cooperative is another local employer that offers such a service. With 80 nurses on staff at its Tukwila-based call center, its consulting nurse service is available to patients within the Group Health network.
Because it’s part of Group Health’s integrated health-care system, nurses have access to patient medical records, including medications and other documentation from doctor visits. “It’s all right there in front of them,” says Mary Sipher, manager of consulting nurse services at Group Health.
Both EvergreenHealth and Group Health staffers cite teamwork, variety, collaboration and a business-casual office environment as among key perks of the job. “But it’s not for everybody,” Sipher says. “You can’t see or touch the patient. You aren’t moving around. Unlike regular nursing, this is sedentary work.”