Do you miss the hands-on care?

[LovingNurse]

I recently moved from floor nursing to triage nursing at a very busy practice. I'm still just as busy (still no time to potty) but it's a different kind of busy and I don't ache at the end of the day. I am, however, already missing some of the things about floor nursing ...I liked doing many of the hands-on procedures that come with bedside nursing, the closeness I'd feel with my patients, and also the freedom of working 3 12's. I like having weekends off now, but already miss my patients and having flexibility the 3 12's provided. I do like my new job, but I guess I'm just a little nervous, wondering if I made the right decision, and driving myself a little crazy feeling a little whiney, cuz I can't have it both ways. Did any of you feel this way when you made the switch?

[petty,s.t.]

What is office triage?

[Vtachy1]

Office triage is an office nurse who takes the calls during the day in the office. Every request for a same day appt *should* be triaged because They make sure the patient gets the right care, the right time, the right place and the right person. For example you don't want someone in DKA in your office, they belong in the ER. And some patients can be treated at home with the proper teaching on what symptoms to look for etc. I think the key to this job would be finding a good group of docs that respected you and did expect you to be a barrier to care, example being the schedule police so that the patients don't get an appointment which eases the practitioner's schedule.

I came from working ICU for 10 years and med/surg before that and also for a general surgeon. So this has been wonderful nursing for me!!!! I only do after hours triage for the docs. The docs hire me so that the patient can get someone coherent to talk to at night that will spend the time with them teaching and assessing them. It is the MOST SOPHISTICATED kind of nursing that there is. You are on the verge of doing advanced practice. And as an RN we don't diagnose, but we must think diagnostically.

[ImThatGuy, BSN, RN]

How does this telephone stuff work? I'm guessing they call with a chief complaint and you provide a telephonic health assessment followed by a recommendation of what to do about it? How far can your recommendation go, i.e. hang up and dial 911, go to the pharmacy and get some Zyrtec, call your doctor for an appointment tomorrow....?

[ImThatGuy, BSN, RN]

Well, that got the big ignore.

[sirI, MSN, APRN, NP]

You need to start another thread instead of tacking on a different topic, ImThatGuy. :)

[ImThatGuy, BSN, RN]

You need to start another thread instead of tacking on a different topic, ImThatGuy. :)

Well, what fun is that! lol

[Vtachy1]

How does this telephone stuff work? I'm guessing they call with a chief complaint and you provide a telephonic health assessment followed by a recommendation of what to do about it? How far can your recommendation go, i.e. hang up and dial 911, go to the pharmacy and get some Zyrtec, call your doctor for an appointment tomorrow....?

It differs state to state. Some states allow you to recommend Tylenol/ibuprofen etc. Some boards of nursing will not allow it even with a Doctor's protocol order.

Telephone triage is a bit of a gray area, kind of new so a lot of states give you a lot of freedom. But it HAS to be an RN with lots of experience. Its kind of like conscious sedation that we used to do in ICU, there wasnt any regulations on it until a few years back. But it makes it nice not to have so many regulations by the state boards it gives us more freedom.

We are allowed to order meds that the doctor has given us a protocol order for (but you have to check your state board of nursing to see what they say about your scope of practice). Each doc is different and each allows us to call in different meds.

But yes, we do an in depth assessment on the patient, state the nursingn diagnosis, develop a plan of care, teach them how to treat it at home/when to call back/when to go to ER or dial 911 or if they need to go to urgent care, or call for appointment in the AM when the office opens. Very rarely do we have to page a doc because most docs will not order pain meds or antibiotics without the patient being seen. We use protocols only to support our decisions, they should never be the only thing you go by, they just help you make sure you havent' missed anything and support your decision.

I don't know why every doc doesn't have after hours triage nurse to take the calls. Most offices have office triage for during the day but not after hours. Especially peds, we get LOTS of peds calls.

[kcmylorn]

I love the telephone triage. Do I miss the hands on? NO!!! I work a temp fill in postion - soon to be coming to an end, person is returning in 2 weeks. I was a bedside acute care RN for 30 yrs- I have had it, I'm sick of it. The clinic temp position has been wonderful, my favorite. I get to use a part of my brain I didn't hink was still ther with acute bedside hospital care. You actually test yourself with what you know - that's the triage peice. Yes, it is bordering on an APN role. You learn to listen- you can't see the caller., it tests your assessment skills- you have to have a 'very' thorough knowledge of pathphys, symptomology and pharmacology(allergic reaction calls) and the end result treatemnt of a vast aray of illness and at different levels. You have be extract from the caller so they are able to clearly and consisely verbalize what you would normally see, listen for, and papate if that patient was in front of you(because you can't see or touch) the caller. You make a judgement(diagnosis) from the caller's answers and send them to the appropriate level of care. It is a wonderful challenge- Ive never done anything like this in 30 yrs. The autonomy is fantastic. But you have to have a vey experienced foundation.( have seen a large variety of illness, in diferent phases and treaments of the same condition on different levels- ED,ICU, med/surg- LTC/rehab discharge)