Published Feb 25, 2002
Do any of you have any info on this "dial - a -nurse " business? I read that it is taking off like a rocket. Even though I have the worst telephone voice on the continent, it sure sounds wonderful to me. The units and the politics, the short-staffing and b*t#hy relatives are taking their toll and a little telephone office sounds great.
In the UK we have "NHS Direct" a health problem helpline staffed by RN's in call centres with computer aided diagnostic software support. They advise on callers medical questions, and suggest appropriate actions. Cuts down on unnecessary visits to Dr. and/or ER. The service is available online, too
Many hospitals in the Seattle area have nurse lines. The advise the nurses give is scripted carefully from protocol books, they document on the computor VERY well, and frequently refer you to call your doctor. Liability over phone triage is a big issue.
Yeah, liability is what I would worry about. When patients call to the floor after surgery looking for advice, the nurses have to be so careful with what they say to them, in case something goes wrong. Why would this dial-a-nurse be any different? Unless they make some kind of agreement that they can't sue. If they were worried about that, they should have gone to see their doctor in the first place as far as I'm concerned...
Good topic to post-
In the AF we've been triaging calls for acute appointments for several years. The goal is to encourage self care for patients with minor ailments that can be handled at home. This is a very labor intensive process with very little return on the investment of RN time. We try to cut down on wasting appointments on patients with the sniffles x 1 day, but a majority still think the doctor will be able to cure them and don't want to listen to advice from a nurse. We often hear, "it's a benefit we're[as military members, dependents etc.] "entitled" to. Actual need is never the issue.
I agree with the above mentioned liability/documentation issues. It's a real pain in the butt if you are going to do it right. I'll always err on the side of caution and bring somebody in if I really can't tell what is going on. (It's amazing how many people don't own a thermometer- you find this out when you ask about fevers!!!)
Unfortunately, the military doesn't have the staffing to do it right and this is a position that will cause burn-out fast!
I hope that it is a better job for those of you in the civilian sector, but I'd rather never work another triage line in my life!
Will love to read others thoughts on this subject!
NurseDennie, BSN, RN
I have a nice voice, I don't think it's about the voice. And I'd love to do something like this too. But I've lost my nerve, I'll bet I'd never get comfortable in that role.
I have a friend that is the nurse manager of a nurse phone triage unit. He has the same head aches with the PTU as any of us have. Short staffing, whining pts, pain in the A** MDs...... If you'de like to PM me I'll ask him any specific questions you have. He works for a large HMO, though, not as a private business. I don't think he's a member here.
hogan4736, BSN, RN
If you're burnt w/ the hospital, or face-to-face contact, then phone triage is the best...I did it for 6 months in Phoenix for an HMO, but they centralized to Dallas...I loved the face-to-face contact break...Not a patient for miles, and we weren't allowed to disclose our location...
Oh, and the liability is covered as long as you document!!!
And I ALWAYS qualified my advice (which was computer generated, and written by docs) w/ advice to go to the urgent care or ER if they didn't want to wait (I hated to do that, but I had to be safe...and besides, 75% of the callers already had their mind made up to go "be seen" after the call...it's as if the call was for their own reinforcement)
If you think patients ask stupid questions or do stupid things in person, then you ain't heard nothing yet!
The phone allows them to hide and be anonymous without the embarassment...
Hogan What are some of the stupid things you have heard?
As to the other points in this thread. It is the liabiliuty issue that makes telephone triage less effective, because one would need to qualify all advice with....go to the doc if you feel it is necessary.
So, how can we slow down unnecessary visits to the MD if our hands are tied? [And to some degree they should be.]
I had a call from a grandmother who was caring for her 2 month old grandson.
She asked why might her grandson be fussy?
I asked the usual questions, then asked about his diet.
She stated, "Well, for 2 weeks we breast-fed him, then my daughter went back to work, so we fed him formula for a little while, he stopped liking that, and we switched to 2% milk, now he drinks whole milk, and sometimes applesauce."
OH MY GOD!!!!!
How do you respond??
Another called and asked, "my husband used to have your HMO, but he switched jobs, and now has a different HMO, but it wont start for 2 weeks. You know, he never used your services in the past, does he have visits saved up (from his last coverage)?"
I received a call from an RN (self-proclaimed, immediately to start the call) whose daughter twisted her ankle. The mom asked if she should put ice on, and what else could she do.
My mom was a teacher, and got by without phone triage when I was a kid. How some of these people get thru their day...
Like I said before, people call for the advice, and no matter what you tell them, they still want to go to the ER (or urgent care)
sharann, BSN, RN
OK, Guess my minds in the gutter..What came to my dirty mind when I saw "Dial-A Nurse" was some knd of 1-900 # where people call to say nurse make it better....
Shame on me!
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