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Melania English, RN, an education coordinator and certified
specialist in poison information (CSPI), laughed at
the notion of a typical day at DeVos Children's Hospital
Regional Poison Center in Grand Rapids, Mich.
"Of the approximately 135 calls that come in each
day, no call is typical," she said. "Because
every call is different, so are the answers, and many
boil down to judgment calls. About 105 of these calls
are regarding an actual exposure, while the rest are
informational."
Here's one example:
Caller: "How do I clean up the mercury thermometer
that broke on my kitchen floor?"
CSPI: "First, keep children and pets away from
the area where the thermometer broke. Do not use a vacuum
cleaner. For uncarpeted areas or countertops, roll the
beads of mercury onto paper, using a stiff card or eyedropper.
Place the beads in a Ziploc bag. For carpeted areas,
collect the beads in the same manner, but cover them
with a nonporous container. Ventilate the house and
keep all heat sources away from the mercury. In all
cases, contact your local health department."
Making the transition to poison center nursing can
be difficult and misconceptions about the job don't
help. "One of the misconceptions has to do with
what a nurse does here. I've been here for 25 years.
I've talked to and interviewed a lot of the nurses.
Their colleagues in traditional nursing roles think
this is like an office job," said John Trestrail,
managing director of DeVos Regional Poison Center. "It's
much more than that. Poison center nursing is as close
to a nurse practitioner as you can get. Because these
people are … providing what treatment they can
over the phone-they have to make an assessment and treatment
recommendations."
It takes a special person to meet the challenge of
treating patients over the phone. "To be able to
do this all without being able to see or touch your
patient and to have the ability over the phone to convey
warmth, confidence and get the answers to the questions
you need to assess each situation and make a determination
takes a lot of skill," English said.
Elizabeth Gallant, RN, a specialist in poison information
at DeVos, has firsthand experience with misperceptions
about poison center nursing. "People think the
poison center is really boring. They think we deal mostly
with chemicals, but we are really doing a lot of nursing.
When the hospital originally calls us, we work out a
treatment plan, we give recommendations and they decide
if they want to use them. With follow-up calls we can
see if there are any new symptoms and if there is anything
different we can do."
After becoming frustrated with the nursing situation
at the hospital for which she worked and through networking
with other professionals in her field, Kathy Toczydlowski,
RN, CSPI, learned of an opening at the poison center.
She had concerns about making the move, however, such
as missing the actual hands-on patient care and losing
the skills that come with face-to-face interaction with
patients.
"We don't have true hands-on nursing here, so
it was a worry of mine whether I would like to stay
in this field without having that face-to-face contact,"
she said. "Even more than that, I might lose some
technical skills, and what would I do if I decided to
go back to the hospital?
"So I went back and worked part time in OB while
still working full time at the center. By going back
and working in the hospital again, I learned I didn't
lose anything. I had to prove to myself that it was
OK to stay in this kind of nursing," she said.
Today, Toczydlowski is going on 23 years at the center
and is as satisfied as ever.
"We are talking to people over the phone and I
get satisfaction from honing my listening skills,"
she said. "Is a mom's tone of voice telling me
more than she's actually said? I'm still using a lot
of nursing assessment skills, so my concerns about missing
patient care quickly went away."
Some of the other benefits Toczydlowski enjoys include
a growing knowledge base of pharmacology. "My basic
knowledge of pharmacology and of the pharmacological
kinetics-cause and effect-has grown," she said.
English said that she has never been as challenged
as she is working as a specialist in poison information.
"You are learning something new every day, pushed
to challenge yourself. It's never boring," she
said. "So many people call with such a wide variety
of questions. You have to know a lot and have to be
able to find out about something if you don't know a
lot about it."
After meeting such challenges, English basks in the
gratification of knowing that she has handled a wide
variety of situations and has successfully triaged and
treated an exposure or answered a question. The relief
in callers' voices and their appreciation after being
helped doesn't hurt either.
Even the drawbacks provide some level of satisfaction.
"We are short-staffed at times-people get sick,
etc. It's like any other nursing situation," Toczydlowski
said. "The thing that makes it different is that
I would go home at night from the hospital and be frustrated
worrying about the patients; feeling like I didn't do
enough for them or didn't see them enough; it was just
too busy.
"Here, I get frustrated-we get very busy-but we
are still able to get our patients treated at home or
sent to the ER or doctor. I'm not as worried as if I
were the one taking care of that person. I know they
are still in capable hands and I will get to them as
soon as I can."
Gallant, who has been with the center for two years,
wholeheartedly agrees. "What I like about [poison
center nursing] is that you do one call at a time,"
she said. "You give them all your attention and
then you finish it. You don't have 18 patients to worry
about at one time."
English, who has been a nurse for 15 years, is excited
about poison center nursing as a viable alternative
to more traditional nursing roles, as well as increasing
publicity and recognition of the career.
"It's a whole different kind of nursing. It's
autonomous. We have good relationships with ICU nurses
in the 110 hospitals in our coverage area. Those nurses
know that a poison center rep is going to call for a
progress report on the poisoned patient. They know,
too, that it's an opportunity for them to ask questions
about the toxin if they aren't familiar with it,"
English said.
Further, through follow-up, poison center representatives
communicate with emergency room personnel and physicians.
A lot of follow-up occurs from the time the caller
first contacts the poison center to the time treatment
has been concluded. In the first 24 hours, a follow-up
call will be made once a shift. After that, follow-up
is done once a day.
"Some hospitals know why we're calling and others
don't," Gallant said. "Of course, we want
to see how our patients are doing, but it's also research."
The information is entered into computers that send
the data directly to Washington, D.C., where trends
are tracked and studied.
"They watch for trends as far as symptoms, epidemics,
anthrax, etc. A lot of the information we have access
to is based on past histories, because you can't do
studies on children, for example," Gallant said.
Contact
Barbara L. Vergetis Lundin at blundin@worldnet.att.net.
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