June 6th, 2011
Healthcare hotlines, telephone triage, and Ask-A-Nurse: these are all names for the same health care phenomenon. Nursing hotlines have been around for decades, and they can save patients and healthcare providers both time and money when a medical emergency occurs. In general, these hotlines are staffed by registered nurses with years of experience in ambulatory care, and now there is even a special area of certification for telephone nursing practice (TNP). The nurse at the other end of the phone helps callers determine the severity of their problems and the most appropriate level of care.
"Telehealth nursing is a subspecialty within ambulatory care nursing with its own body of knowledge and expertise," said Charlene Williams, MBA, BSN, RNC, BC, president of the American Academy of Ambulatory Care Nursing (AAACN), and a telehealth nurse employed by WakeMed Health and Hospitals in North Carolina. "[They] assist callers to make informed decisions about health problems they may be experiencing."
Telehealth isn't a new concept, either. In fact, you could say healthcare hotlines are as old as the telephone itself — the first call made by Alexander Graham Bell was reportedly for help following a battery acid burn. Moving on into the 1970s, a number of health maintenance organizations (HMOs) started manning phone lines with nurses in a move to save money on doctor's visits by the insured they served. In 1990, the term "telephone triage" appeared on Medline indexes—a formal acknowledgement for the new subspecialty.
Industry and Employment
Today, telehealth and telenursing are quickly expanding fields. The International Council of Nurses (ICN) expects home health jobs to rise by 36% or more in the next seven years. The ICN also projects almost 46% of home visits could be done through telenursing. Western countries like the United States and Great Britain have seen the greatest growth in the telehealth field, but developing countries are benefitting from the new technology and training.
Like Williams, many telehealth nurses have 10-20 years or more of clinical experience with superior assessment skills often gained while working in hospital emergency or acute care departments, pediatric services, dialysis centers, home health and other nursing specialties.
"Telehealth nurses have a broad-based experience in caring for both adults and children," Williams pointed out. They must be patient with callers, speak clearly and have good active listening skills. Other characteristics that will help in your work are the ability to think independently, multitask, type, and talk and listen at the same time.
Nurses employ their full range of skills when talking to a caller: assessment, information gathering, counseling, lifestyle management and health system guidance. A skilled TNP will ask focused questions in a timely manner to evaluate and offer a plan of care.
On the Job
A TNP can help callers avoid the time and expense of seeking an inappropriate level of care. No one should waste time and money in an Emergency Department if the problem isn't really an emergency; however, some calls will require emergency assistance and the TNP can assess the symptoms and immediately instruct the caller to dial 911.
Another major focus of the specialty is providing educational advice and emotional support. Nurses who function in this role find it rewarding to draw on their full complement of nursing knowledge and experiences in assisting clients through the maze of healthcare.
Besides being available for potential emergencies, telehealth nurses are often teachers. During calls, they are as likely to explain drug interactions, provide diabetes educational support by explaining how meters and test strips work, or even monitor health conditions for senior citizens who live alone. And, they are available 24/7.
It is not unheard of for a caller to receive a follow-up call from the TNP, checking on the outcome of the advice offered earlier. Patients who repeatedly use a TNP service often request to speak to the nurse with whom they have formed a relationship. Nurses on the triage team find this one of the most rewarding professional experiences.
TNP nurses often fall back on teamwork in their triage work and assist each other with support and expertise during patient telephone contacts. Problem-solving is often the focus of the triage effort and entails a wide range of details: assisting in a referral for a medical specialty, arranging for transport to hospitals and answering health insurance.
Telehealth is one of a few specialties where the nurse can regularly have a direct impact on the client's healthcare. Rewards come not only from immediate feedback but also from the knowledge that the art of nursing is alive and well.
Education and Accreditation
Most telehealth call centers are accredited by the Utilization Review Accreditation Commission — now known commonly as URAC — a Washington, DC-based healthcare accreditation and certification organization. URAC Health Call Center standards apply to organizations providing triage and health information services to the public when conducted by telephone, online, or through other communication outlets.
According to URAC, its standards assure that RNs, physicians "or other licensed individuals perform clinical aspects of triage and other health information services with timely, confidential and medically-appropriate care and treatment advice."
Nurses have always been involved in direct patient care, counseling, teaching and problem solving for clients and families, but the practice of professional nursing has changed dramatically in recent years. In this age of computers and instant telecommunications, a nurse is just a phone call away.