I work agency at a hospital where I'm expected to do triage. I've never done it before and they don't seem to care. What type of skills or assessment do you need as a triage nurse that differs from being a regular L and D nurse?

This note will be long but I hope you find it useful:

I wear several hats myself. First, I am a telephone triage nurse for a busy OB-GYN clinic/office as well as an inpatient OB-GYN nurse in an attached community hospital. I also teach our childbirth classes two times a month for our patients. We care for about 70 births a month, so we are a smaller hospital, which I like, because I get to know our clients/patients.

First, let me tell you, it takes years of experience and solid critical thinking skills to be successful in telephone triage. You have to be able to know what you need to forward to the doctors to answer and what you can answer yourself, first of all. Not all questions need to go to the physicians! You need to have the experience and know-how to answer some things yourself. You need to know your drugs and your gyn and ob as well as post-partum issues. You will also be need to be to do the research to know what prescriptions to approve and fax or e-RX to the patients' preferred pharmacies as well. (you will have to know things like when the patient's last pap smear was done and what result was to know if she can have more birth control pills or HRT, for example, or if she needs another exam before approving the request).

Also, you will have to know what problems to triage first, knowing your priorities. The order of calls will not necessarily be the order in which you answer questions or problems first, in other words. Urgency obviously takes priority, just like in the ER. You will have to be extremely organized. You will be getting constant interruptions in your day, so you will have to be able to hold it together and keep track of things and know how to stay on top of the issues that come across your desk. Doctors will come in and have questions all day long, as will medical records and front desk and lab personnel.

Also, solid computer skills are a must as most triage nurses use computerized triage systems these days. First, the reception area will receive your calls and send them to you via computer, you will pull them up, read them and answer them via that same computer system. Our system is called Digichart. It is the means we use to chart on all OB-GYN patients and communicate with the doctors, nurses medical assistants, lab, medical records, and also to keep patient records up to date. Also, the hospital uses this system to pull up patient records when patients present over there in labor or for rule-out , NST's, Blood pressure, checks, etc. So we have to constantly keep the system updated in both the hospital and in the dr office. We also use another computerized scheduler to check the physicians', ultrasound's or lab's schedules to see when they have room to fit patients in for urgent appts or to see when our dr's are in surgery, on vacation, or not in the office, etc. It also shows who is on-call for questions, evaluations, etc.

Of course, you have to have excellent communication skills and be an outstanding listener. You will field dozens of calls a day and will have to be able to flesh out very quickly what the real issue is with your patient in order to be able to serve her needs in the most efficient manner. You will need to know when you are in "over your head" and when to refer your patient to her PCP or the ED right away, also. Not all issues are appropriate to be handled in the OB-GYN office and you need to know when this is the case and refer her at that point. The OB-GYN doctors rely on your judgment a lot here.

Every single call, no matter the nature, is logged into our system, along with how we handled it, e.g. if we sent it to the physician, or answered it on our own, etc. Also, e-RXs are logged, as well. Patients are then notified as to what action has been taken and if they need an appt, they are trans fered to the front desk to make an appt. We also do all nurse appts ourselves for blood pressure checks, urine dips for protein, sugar, infection, etc and obtain scripts from the dr on-call for the patient, as needed. We stay quite busy all day. I really like this job a lot. Never a dull moment and variety is the spice of this position! You get to know the patients quite well often.

We are the "go-to" people for the medical assistants for nurse-advice questions and information as well. We make the nursing judgment calls for these folks in all such cases.

One more part of my job is to call all our patients back with their test results. The doctors send the results to us via Digichart and we are to interpret these and then call the patients with the results, explaining them and any actions on their part necessary if needed, like follow-up etc. This is usually easy,but can get complicated, esp if the result is not what they desired or is negative, as you might guess. We also send referrals to specialists as needed for our patients, via fax. This gets time-consuming and even frustrating, when insurance gets complicated, as you can imagine. Also frustrating is when telephone tag gets in the way because, due to HIPAA, you can never leave results via answering machines or voice mail. Only with the person or someone designated by that patient herself.

Another part of our job is to track people who don't show up for appointments----did not keep appointment or "DNKA" (Pronounced DINKA). These names show up on our task bar in Digichart, as well . We are to call them and and remind them they did not make their appointment and ask them to reschedule at their convenience. We call them every other day x3. People who are non-compliant ultimately receive letters from our office, releasing them from our practice explaining why. We also complete disability letters for our pregnant patients and those having had surgery for their jobs.

One more duty is for us to rotate into the Education Room whereby we do intakes for all the newly-pregnant OB patients and set them up for their labs, urine dips, and initial ultrasounds and give them their education and gift bags. We also give them pediatrician lists, their "welcome to OB letters" to orient them to the OB unit, and set them up with information for birth classes and tours of the OB unit, as well. Then, we order their first OB appointment at 9-12 weeks' gestation, Penta screens, and any additional screens based on risk, family history, etc. This is my favorite responsibility of all. I just love doing this job. Meeting all the different people who have just found out they are pregnant (they are usually just about 5 or 6 weeks' along and so excited) is the best part of the job. I feel very fortunate doing this.

You can see, there is a LOT of responsibility attached to this job, a lot of decision-making and the patients and physicians, as well as the staff depend on us heavily for our good judgment in all cases. So that is why I say a lot of experience is is needed to be able to do the job well and with confidence and skill. If you don't have a lot of experience, this job may not be for you.

I don't know if all tele triage nurses do all we do; it seems like a lot but we do keep busy and that is what I love about this job. Be sure to ask what responsibilities you would have when you are interviewed, of course.

If you are lucky enough to score a job like this, I hope you enjoy it. I think you will like it because you will never be bored and the people you will talk to you will be so interesting! It truly is never boring.

I hope this helps. If you have further questions, don't hesitate to ask!

I work agency at a hospital where I'm expected to do triage. I've never done it before and they don't seem to care. What type of skills or assessment do you need as a triage nurse that differs from being a regular L and D nurse?

A strong sense of patience and diminished sense of smell.

Being able to multi-task, being able to make good decisions quickly, and generally being sharp.

If you're wishy-washy and can't decide "well, MAYBE she's in labor, let's watch her for another two hours" or "well, nitrazine was negative and there was no ferning, but it sure SOUNDS like her water might have broken" then you may not be the best at triage.