Telephone Advice

Specialties Emergency


I have recently been appointed interim nurse manager of the ER I work in. . . I have no intention of applying for the job! BUT while I am acting in this role there are a few things I would like to change.

One being nurse calls. Our current policy states that the call should be brief and medical advice should not be given over the phone.

We (the nurses) would like to see the calls stopped all together. The powers that be feel it is good customer service. We see that it upsets people because we talk to the callers in circles. Nursing also sees it as a safety issue. We do not document these calls, we are pulled away from patient care, the callers press you and press you for any bit of information. The calls make us miserable.

I have tried doing some searches for articles on this risky behavior and must not be using the right search words, as I am not having any luck. Does anyone have any policies, words of wisdom to share. I would really like some articles that I can go to my boss with showing why these calls are a bad idea. Does anyone use scripting? Has anyone been successful in un-publishing their ER phone number? How did you gain switchboards cooperation - they turf everything to us that they don't know what to do with. Any help, advice, direction, links, whatever would be appreciated.

I do realize that we have an obligation to patients we have recently seen, but I am talking about the "my kid has a rash that looks like . . . "


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teach the people who answer the phone "all the nurses are treating patients with emergencies right now, none have time to come to the phone. feel free to come down and we will take a look at it"

i believe, that if you can make a phone call about it, that its not an emergency.

also, by saying that sentence above, people will get the idea that its busy and not want to come down.

I agree that this sounds like risking personal and professional liability in the name of customer service. BTW, what kind of service is it if you cannot give them what they really want (free info)? I used to take call for MD's and people got angry when I hedged around, not realizing that (a) I could not diagnose or practice medicine without a license and (b) even an MD ought to be able visualize the patient to assess them. Otherwise, the pt. is at risk. Also, this does not show respect for the nurses or for the patients being attended by them. The clerk could just say "Sorry, we are not allowed to give medical information over the phone. Please call your physician, or come to ER". Nuff said.

Dixielee, BSN, RN

1,222 Posts

Specializes in ER.

Usually our triage nurse fields those calls, but they come thru the clerk first. The caller is told that the nurses are busy, but when one is available, they will get to the call. If we ARE available we will answer it, but if not, the caller usually hangs up. We do not take numbers and call people back as the caller sometimes requests.

Our canned answer is basically..."I'm sorry, but we are not allowed to give medical advice. If you are concerned, please call your physician or we will be glad to see you in the ER."

Generally they will try to slip in a quick question, and we must tell them for liability reasons, we are not allowed to give any advice, and stick to it. Most do understand the liability issue. In fact we have notes posted in the ER telling us NOT to give medical advice because we cannot visualize what the caller is trying to describe and we will be held liable if there is a problem because of our "advice".


248 Posts

Specializes in 6 years of ER fun, med/surg, blah, blah.
teach the people who answer the phone "all the nurses are treating patients with emergencies right now, none have time to come to the phone. feel free to come down and we will take a look at it"

i believe, that if you can make a phone call about it, that its not an emergency.

also, by saying that sentence above, people will get the idea that its busy and not want to come down.

You're a genius! But don't forget about our job security.....


138 Posts

i have always wondered how a pt can be treated when they are not in the same room. um, i dont know-- there is a drop down menu where you can go to nurse specialties? (on this site). and from there to telephone triage nursing (again, i do not understand how one can do triage over the phone, but i guess that is just a big gap in my knowledge). maybe if you posted there somebody might have some horror stories that would convince management to stop this because it really does sound like nonsense. or maybe under nursing specialties there is another group that would have some stories-- maybe even under legal category?


138 Posts

haha-- one time i got some chemicals in my eye, it was degreaser. i called a number-- it was either ER or it was the number on the back of the package of degreaser. (what happened was, i used it in a pinch to clean the bathroom and did not rinse it off and then i washed my hands and when i touched my eyes to take out my contacts it got in them--cause it was on the taps). (it caused excruciating pain that did not abate with time).so, somebody told me to rinse my eyes for a long time under the shower. this did not help at all!!! so i called a different number-- either ER or on the back of the package-- and talked to someone else, i think it was ER that time. and they said, "That stuff is corrosive! If you'd kept rinsing, you could have taken your cornea right off!" Ooops. (Sorry if cornea is wrong term. they couldve said sclera or whatever-- i get the parts mixed up).---OH my God! this is a very good argument in favor of telephone nursing actually. i could have lost both my eyes! (well... in effect, anyway.) now i feel like i should have sent the doctor a thank-you note. i did not go straight to ER because i was not sure of how much they could do and it was like an hour away. wow-- to all ER nurses, thank you. oh-- i know it pisses off many ER people when we are there without an emergency. just for clarification, it was super late and my doctors office was closed.


444 Posts

We do not give ANY advice over the phone. Once you establish rapport and contact you are establishoing "duty". Now you are in trouble because you cannot see the patient, you cannot assess them, you don't even know if the person you are talking to is who they say they are or are telling you the truth. But you have established a connection with this patient and now have a duty to them. Way dangerous.

We are looking into a phone answering system that another hospital's ER uses that instructs people-

-if they have a medical emergency to call 911

-if they want advice we do NOT give it

-if they want medical records push...whatever

-if they want test results we do NOT give them over the phone...

It is very cool.


22 Posts

I love it when they describe their rash and want me to identify it and tell them the treatment. We do not give advise over the phone, but for the "my husband has crushing chest pressure/is unresponsive on the floor" we tell them to call an ambulance and come right in.


1 Article; 1,327 Posts

We aren't supposed to give advice over the phone, but sometimes it is hard not to. We are supposed to leave decisions about whether to come to the ER or not up to the patient (or the person calling), but when someone calls and says things like, "My mother is having chest pain and she is blue around her lips," it seems pretty negligent to to not say, "Hang up the phone and call 911." Also...if someone calls and tells us they have such and such a problem and want to know if it is OK to do something that is can we not tell them not to do it? "My child has a fever of 105° and she is complaining of being cold...should I put a heating pad under the 10 blankets I already have piled on her?" Ummm...nooo. The worst is whem my husband calls and wants to know what to do if one of our kids gets sick...I've been "busted" more than once for giving advice on the phone...LOL.


127 Posts

We aren't supposed to give advice over the phone, but sometimes it is hard not to.

I know it's really hard not to give advice over the phone, but as an ER nurse who previously worked in a telephone triage for several years, I avoid it as much as possible.

I refer folks to 911, poison control, the closest telephone triage center, the local pharmacist, their own doc... Of course, I do give directions to the hospital and info like that, but I try to avoid giving advice as much as possible (and I know it's hard, some callers are very persistent).

The nurses who do "official" telephone triage get demographic info from the caller, a pretty comprehensive medical history and are following well researched protocols. And they are documenting all of this information. In the ER it's catch as catch can.

Since I've been working in the ER one baby died because the mom was advised to change the child's formula (baby was vomiting) when the baby actually had a bowel obstruction. Diabetic guy was told to soak his foot in epsom's salts after stepping on a nail; ended up losing his foot because the water was too hot and he couldn't feel it due to peripheral neuropathy. I've hear nurses tell moms to give babies less than 3 months old Tylenol for fever instead of telling them to have their baby medically evaluated immediately.

And, unfortunately, I've heard everybody and their brother give phone advice in the ER: tech, EMT, secretary... Like I said, it's hard to resist the patient calling.


444 Posts

No no on the phone advice...

Except that I DO give directions to the hospital...

the one down the road!!!!!!!

:rotfl: :rotfl:

Just kiddin'


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