Position morphing into more care managment, less triage

[FLO4Life]

I accepted a phone triage nurse position earlier this year with a large family medicine practice. It was a new position that sounded like an awesome opportunity to put my ED triage skills to good use. I wasn't replacing anyone, so I was looking forward to starting from scratch.

From day one I was encouraged to "make" the position my own; to create workflows and protocols that would not only streamline phone triage, but also emergencies in the clinic. The providers and the MAs were thrilled to have an RN in the office finally, and I was definitely welcomed with open arms.

The honeymoon lasted for about a month, but slowly but surely I'm finding that my duties are becoming less to do with triage and more to do with managing patient care; something about which I don't know jack and frankly don't have much interest in pursuing. First it was following up with patients discharged from the hospital. Next, reaching out to patients that've been to the ED more than 10 times in the last year. I have no desire to spend my day reaching out to "high-utilizers" to find out why they've presented to multiple EDs 115 times over the last year drunk. Or to the poorly controlled diabetic with an A1C of 14 who's been admitted to multiple hospitals in the last year in DKA.

There's definitely a need for this role, but I ain't it. I don't (nor do I want to) bring much to the table in the way of case management/care coordination. Right or wrong, I lack the empathy and patience needed to "really reach" these people. Don't get me wrong, I try to care, but I can't care if the patients themselves don't care. This isn't what I signed up for!

Any suggestions about how I can convey this to my supervisors without sounding like a cold-hearted, Nurse Ratchet? I know that I'll be setting myself up for failure and won't last long in this position if I don't speak up, but I'm worried that voicing my concerns will have me labeled as not being a "team player."

[klone, MSN, RN]

Honestly, care management is the future in the nurse's role in the ambulatory setting. If it's not something you're interested in doing, I'd suggest looking elsewhere for a job that fits your needs.

[pfchang]

Are there patients who are not getting triaged who should be? Are appointment slots utilized properly? Maybe there is mot enough for triage all day, every day. As klone mentioned above, care mgmt and coordination is essential in ambulatory care today. The offices are being rated on keeping frequent flyers out of the ER and for getting the HgbA1Cs down and BPs down. They are submitting data showing how well they are reaching practice goals.

Maybe a true urgent care would be a better fit for you.

[klone, MSN, RN]

The offices are being rated on keeping frequent flyers out of the ER and for getting the HgbA1Cs down and BPs down. They are submitting data showing how well they are reaching practice goals.

Absolutely. Look up HEDIS measures for Adult outpatient. This affects reimbursement, and as the only RN in the clinic, you are an integral part of it. I would say that perhaps the role they want has outgrown what you signed up for, if that's not something you're willing/interested in doing.

[LadyMonteCarlo]

I am a phone triage nurse for a very busy cardiology practice. If triage you want, then, you will definitely get in cardiology. We have a very high acuity level. Yes, managed care especially for the chronically unstable CHF patients, B/P issues out the wazoo, arrhythmia heaven, AND you even get to break open the crash cart every now and again. Hope you find what your are looking for and best of luck.

[FLO4Life]

Thank you all for your suggestions and input. I hope that I'm able to embrace the position for what it is and what it's becoming. I've volunteered to help staff athletic events and sports physical sessions on a day that I'm not working, and am considering picking up a few PRN IV therapy shifts.

[Katie82, RN]

Think of this as an awesome opportunity to gain case management experience, which will be a big factor in the future of nursing. Make the position your own and make yourself indispensable. Then if you need additional help with triage, ask for it. Have been both, and I would rather be a CM than a triage nurse any day.

[needlesmcgeeRN, ASN, RN]

This is exactly my position - Care Coordination/Care Management...a little bit of triage here and there, usually for the patients that I care manage, but sometimes for our other patients. I "feel your pain" on those repetitive ER patients! It can be frustrating. :)

[Katie82, RN]

ER Utilization is one of the greatest challenges of Care Management. We have become a culture of getting things done as quickly as possible, and many patients don't want to wait for an appointment or comply with follow-up. Trying to convince folks that an ER visit is not only a longer wait, but a lower quality of care for chronic problems has always been like nailing jello to a wall.