I'm an old RN who just started working primary care/clinic in the past 5 months. We have 13 providers- a mix of NP's, PA's and MD's. We have Family practice, Women's Health and Peds. We have 5 RN's- 1 RN/ 2 providers, except Peds which has 1 RN/3 Pediatricians and Women's Health has 1 LPN /2 providers in addition to 3 tech's for each Nurse/provider team. All 5 of us RN's do triage. LPN's and tech's are not allowed by state law to do triage. Only an RN can triage patient's. I think this is for all 50 states but check the Ambulatory Care speciality website(AAACN). Yes, we have protocals- our 2 references for protocals are Woodke and Barton Schmidt. (A good general over view resource book is the Ambulatory Care Core Curriculum Textbook) When we do symptom based telephone consultation(encounters) we have to site the protocal in our documentation- esp. in Peds.( this is what covers your butt) We have all computer documentation- the format: we call a "t-con". Our call line directs calls to the appropriate RN and is based on who the patient is assigned to as their PCP. Each nurse provider team has approx. 2,500 patients. I would receive the call from the appt line if the patient was assigned to one of my 2 providers, The patient is already in our computer system so I look them up based on the SS# and the DOB, I listen to the pt's c/o, ask history based questions- ie: vomiting. I know to ask the when it began, associated sx, any fever/chills,nausea, diarrhea, pain- pain scale characteristics of the pain- this is where it gets sticky, you real have to listen to what they are NOT telling you because you can't see them- are they anxious or calm, do they really mean abdomen or is it flank, are they drug seeking or hemorrhaging, you just have to go with the flow of the conversation, direct your questions and know the s/s of other posibilities/ conditions, and make a decision from there- either call 911( in which case you can NOT tell them to do, conclude the conversation and hang up the phone. You have to get another staff person to call 911 and stay on the phone until 911 arrives there) Or direct them to the ED, urgent care, make an appt for today or can it wait for a few days or can it be the flu-home remedies. This is where the protocals come in. Those protocals are like the algorithms of the ACLS- If this, do this- this is the CYA of triage)Never are you 'winging it'. I then electronically document the entire patient conversation and the outcome/disposition of the patient.
We also have what is called"nurse run walk in clinics" for UTI, URI, sore throat, Depo injections and B-12 injections. We have facility protocals for these also. The pt's have to meet certain criteria. If they don't they have to make an appt. The check-in clerks call the appropriate nurse, I would get the pt form the waiting room; bring them back to the exam room, get their vital signs, ask the history questions related to URI or sore throat. I do a focused assessment- listen to the lungs, look in ears, up noses and in throats. I run my assessment by the provider. They tell me what to order( give me verbal orders), I take the verbal order, enter it into the computer and go back to the patient- and do all the teaching. I then document my assessment findings in the SO section(subjective/objective) in the computer, if labs need ordering example: a throat c/s and rapid strep, I go ahead and collect them during my assessment and enter them into the system( or the lab won't do them) all the teaching and interventions get documented in the EMR note section. To me, it's like an APN without prescriptive priviledges. The patient doesn't even see the provider- only the nurse. The provider during all this is continuing with his every 15 min regular schedule office visits with the tech to assist him/her unless they want meds given then the RN's have to give the meds.( example: a pt comes in for a check up with a BP 210/110, provider wants catapres given, the RN has to give it. or someone is dehydrated from vomiting all night- the RN has to start the IVF or a IM of toradol for pain) Our EMR program has templates for the nurse walk in clinic. It's a point and click program. If a URI or UTI, I would chose the template for URI or UTI or depo injection or b-12 injection and fill in the VS, assessment, intervention (med given w/dose).
Clinic and clinic triage does have it's legal implications and yes there is supposed to be "written" protocals. For me- I love it, It bets the hospital any day. After 30 yrs I hope to NEVER go back. I have died and gone to nurse heaven. After 30 years, I finally get a lunch and a pee break.