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."

Is it really nursing?

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."

The bigger picture

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.