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Blue Shield of California	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
The Blue Shield program operates its nurse telephone triage program around the clock. El Dorado Hills (Calif.) call center nurses Barbara Taylor, RN, (top) and Catherine Stoppani, RN, (bottom right) offer advice over the phone and on the Internet.

It was early evening when the woman called the telephone triage line explaining that her infant son seemed inconsolable and was experiencing long crying jags.

Star Heer, RNC, BSN, a telephone triage nurse at St Joseph’s Medical Center in Stockton, Calif., put the caller at ease while gathering information on the infant’s health. In talking with the new mom, Heer discovered the baby engaged in irritable crying every evening, usually after his afternoon feeding.

Heer asked a series of questions and assured the mother she was doing everything right. She told the caller it sounded as if the baby might have colic, and she suggested several soothing strategies. Because the baby had no other symptoms, she recommended that the mom practice the techniques for the next several days, and encouraged her to call back at any time if she had any other concerns or if the baby exhibited other symptoms.

For patients, telephone triage or advice nurses such as Heer offer a virtual lifeline to health services 24 hours a day, seven days a week. These nurses, who have specialized training and experience, offer callers everything from symptom assessment to home treatment advice, referrals, and crisis intervention.

“Unfortunately, many of our nursing colleagues still think telephone triage isn’t real nursing,” Heer says. “Since what we do is a relatively new area of nursing, I’m not sure everyone fully understands our function or potential.”

Valuable service

Yet patient satisfaction surveys and the sheer volume of calls seem to indicate these nurses provide a valuable service. HMOs that offer advice nurses report enhanced patient satisfaction, and nursing advice lines are being offered by many health plans as a standard benefit for members.

At St Joseph’s Medical Center, nurses answer between 15,000 and 17,000 calls each month.

The call center, founded nine years ago, contracts with local Catholic Healthcare West medical facilities, acting as the community call center for the Stockton area.

In roles that could be compared to air traffic controllers or emergency dispatchers, telephone triage nurses often are required to make valid assessments under conditions of uncertainty and urgency.

Although nurses have established protocols for a variety of conditions and ailments, they must have a minimum of five years’ nursing experience and are required to have excellent assessment skills and be able to work under
pressure.

Challenging calls

“The psychiatric calls are among the most challenging,” Heer says. “You have a patient who may be anxious or depressed, and it takes a great amount of time just to calm them down to obtain relevant information.”

Although the St Joseph’s call center has a benchmark of calls lasting eight minutes, psychiatric calls can often take up to an hour.

Telephone triage nurses at St Joseph’s cannot make appointments for patients, but they can advise patients to go to the emergency department or connect them to their physician’s office to schedule an appointment.

Two years ago, Heer became one of the first nurses at St Joseph’s to achieve certification in telephone triage.

Nurses must pass an exam to achieve RNC (registered nurse certified) status.

“It’s gratifying to see the field become a recognized area of certification,” Heer says.

“I hope to see our roles expand even more with telephone triage nurses being utilized more as a point of patient contact and assisting with the need to triage for ED visits.”

Heer has been a nurse for 29 years, and has worked as a telephone triage nurse for the past eight years. She hopes to work at the call center until she retires.

“I enjoy the diversity of calls, and I’m very proud of the service we provide,” she says.