As of August 1997, the Telephone Nursing Telezine has been in existence for one full year. The introductory online issue was launched in August 1996 and was located at the ally.ios.com server. In June TNT moved to a new location at www.katsden.com.
As I cut into TNT's birthday cake, I wish I had archival statistics to share with you on readership. Due to the fact that "counter" services were not available until this month, I cannot do that. And even the last months statistics will be colored by the fact that TNT lost some readers due to the sudden page move.
What TNT can share with readers is --
in just over a month and a half (since June 16, 1997) the following has occurred.
I hope the practice of printing and distributing the ezine freely for educational purposes continues, as not only is it encouraged, but SHARING is what this ezine is all about. Of course the online version is much more interesting in that you can follow the links to other informative websites.
The most important part of this introduction to the FIRST BIRTHDAY issue of TNT is to thank each and every one of you who continues to read, share and offer encouraging words about TNT and what it means to you. And a HUGE thanks to those who have submitted original articles and materials to TNT. YOU are what makes TNT a true clearinghouse for information on Telephone Nursing...the best nursing specialty in the world!
By Kathi Webster BSN RN, Editor
Summer is here and along with it one of the hottest issues that could simmer up for nurses everywhere.
The Bad News: Some health care executives at major corporations waver over the idea that "real" nursing is done over the telephone.
The Good News: Telephone nursing jumps a major hurdle with recognition of specialty in a draft definition of telenursing. State boards of nursing are alerted that the committment to an interstate compact for nursing licensure is vitally important for all in the nursing profession.
The National Council of State Boards of Nursing (NCSBN) has released new information about recommendations for interstate telephone nursing practice that will have a major impact not only on telenurses but on all nurses in the United States. The NCSBN is a not-for-profit organization whose membership is comprised of the boards of nursing in the 50 states, the District of Columbia, and five United States territories.
A 12 member Multistate Regulation TaskForce (MSRTF) was appointed by the NCSBN in 1996 to develop a regulatory concept incorporating the characteristics of a multistate license. While gathering information on the subject of interstate licensing, a special focus was placed on telenursing and interstate activity. Telenursing is a relatively new practice modality and the technologies used (including the plain old telephone system) has raised issues of practice across state lines, not unlike those concurrently being raised in telemedicine.
It is old news to telephone triage/advice nurses that some within the ranks take calls from patients in states others than where the nurse holds a license. This practice is especially common in large health maintenance organizations and health management (or "demand management") telephone nursing service bureaus that serve a national population. In addition, nurses working in health organizations bordering several states are also likely to counsel patients who do not live in the state of the nurses professional licensure. In the absence of clear guidelines or censureship of the practice, nurses have been using the telephone to assist patients with their healthcare needs across state boundaries for many years. Indeed even the Internet is used to share health information with patients.
With a changing healthcare delivery system in the US, our patients are not those confined within the walls of a healthcare institution, but instead are out there in the community. The use of the telephone by nurses to provide health information, counseling, after-office-hours support and advice has steadily increased in this new environment where keeping patients at home and healthy is a goal. Nurses have been proudly at the forefront of this movement to provide health information where and when the patient needs it most. Although clearly the vast majority of interventions are within state boundaries, it is not a secret that some are not.
Among the goals of the MSRTF was to assess the current interstate nursing practice in the healthcare industry. Their qualitative report conducted by the research firm TVG Inc., was completed in April 1997. It explored the current and projected use of nursing professionals within "managed care" to deliver healthcare on an interstate basis. This approach was based on the increasing trend of employing nurses in positions performing pre-authorization for care, case management, and health demand management. They conducted 40 telephone interviews with executives from major HMOs to telenursing and telephone triage/advice centers. Over 25% of these executives appear to be VPs or Directors of Nursing. Individual responders names and credentials are not listed, however titles, organizations and addresses are.
In reading "The Interstate Practice of Nursing: An Assessment of Current Practices in the Healthcare Industry", I was shocked to discover that these national leaders admit that outside of traditional roles in patient care settings, they were unsure what constitutes nursing in the 1990s. They felt it was difficult to judge whether particular functions are nursing or not, including the role of nurses on the telephone.
A notable comment from the report states in telephone health systems, these leaders questioned:
whether nurses or physicians are functioning in a medical or executive capacity that requires licensure, or whether they are functioning in a medical or executive capacity that might build on their professional knowledge, but does not involve hands-on application of that knowledge.
Some respondents felt that advice given over the phone could be delivered by any trained individual. Others admitted it was a very gray area. Using the traditional operative definition of nursing to include hands-on care, the majority of respondents do not perceive the interstate practice of nursing to be widespread or a problem. Respondents agreed that fewer nurses will be employed in hands-on care in the future, but that demand will increase in non-traditional areas. Conversely, most respondents felt that individuals with a nursing education and experience will be increasingly sought for positions in demand management, disease management and telemedicine. The majority of respondents suggest a licensing system for nurses similar to driver's licenses.
They felt if the current licensing system was strictly enforced, the demand for nurses in telehealth positions would decrease. Why? The assumed answer is they would likely hire non-nurses to perform the role.
From a nursing standpoint, this report is grossly disturbing. I officially nominate the summary be subtitled "The Ostrich Report". For years telephone nurses have been acutely aware of the importance of the nursing process and excellent critical thinking skills for safe and appropriate telephone health advice systems. We have been required to hold a current nursing license as part of our employment and we told we were hired to perform telephone nursing services. Yet now when placed upon the hotseat, some telehealth representatives state they didn't realize these telephone interventions might be considered actual nursing practice.
Telephone nurses have worked diligently for years to earn well-deserved recognition that telephone nursing is a specialty of nursing. Now you can read for yourself a summary of what some leaders say when confronted with difficult questions about telenursing and licensure.
We might also ask to whose advantage is the positioning of telephone health advice as not real nursing practice? It would allow organizations to replace qualified nurses, physicians and other healthcare professionals with unlicensed "trained" individuals to answer the phones and give health advice to patients. These employees will sidestep licensure issues and undoubtedly work for lesser pay. It might further alleviate anxiety that previous activities walked a gray line in the legal arena of licensure.
Perhaps we should be quick to trademark such program names as "Dial-An-Unlicensed-Assistive-Person" or "Ask-A-Person-Off-The-Street" Health Line. Perhaps this is an answer for the rise in the unemployed homeless. We can give them six weeks of training and hire them on the telephones answering health questions for the public. After all, they only need follow algorithms like a trained monkey, and they would be grateful to sleep in a dry and warm place under their desks. Yes, of course I am being intentionally sarcastic. It is my response to a document that appears to show high level denial of the important role that thousands of nurses have played in telephone nursing health services for many years.
The full report is available from the NCSBN website and is linked below. I suggest that all nurses download and read it carefully and form their own conclusions from the material. Since it is supplied in a PDF format, the Adobe Acrobat reader is needed to view and print it.
[Click [here] to download "The Interstate Practice of Nursing: An Assessment of Current Practices in the Healthcare Industry (A PDF file; size: 663k)]
[Click {here} to download Adobe Acrobat reader for use with PDF files]
In contrast to the above report are the results of the informal survey conducted by the NCSBN in their publications and via their website. This survey was featured in the April/May issue of TNT as an alert for telephone nurses to participate.
The two questions asked were:
The NCSBN and the MSRTF deserve applause from nurses for their response to the information they have obtained from their surveys and meetings. In the interim report of the MSFTR, work to date is summarized including:
Telenursing is the practice of nursing over distance using telecommunications technology. Telenursing occurs at any time nursing skills and judgments are used to address the needs of a specific health care client.
This draft definition if accepted will clarify that telephone nursing is REAL nursing after all, and that using the telephone to address the needs of patients does not negate our professional status. It further clarifies that nursing is not limited to "hands-on" practice, and that technology offers us other modalities within which we can practice.
This nursing lisensure model resembles a drivers-license with common requirements for licensure and common language and mechanisms for cross-state disciplinary procedures.
An interstate compact of boards of nursing, if accepted, would allows nurses in states accepting the mutual agreement to be more mobile, freely accessible to patients both in person and on the telephone, and provide for a centralized and one-source database for a nurses qualifications for practice. Mutual recognition would most likely be accomplished via an interstate compact which would provide for sharing of information and for cooperation in disciplinary processes, as well as the basic mutual recognition of licenses.
Boundaries to the recognition of this interstate compact are evident. State regulatory boards and governmental bodies would need to accept the resulting loss of revenue likely to occur in a transition from single state nursing licensure to interstate licensing. Assuring accessible, quality, cost-effective health care especially to rural and under-served populations via the removal of licensure-related obstacles would need to be seen as vitally important.
The NCSBN has already disseminated communiqués to all boards of nursing on this topic as well as to over 7,000 nursing board members, educators, state agency officials, nursing organizations, and other related groups.
Early postings on the NCSBN website seemed to indicate that recommendations on this interstate compact were to be proposed for adoption by the membership of the NCSBN at their annual meeting from August 19-23 1997 in Chicago IL It appears from later statements that this particular issue may not be included on this years agenda and references to the interstate compact is noticeably absent from the web-version of the agenda.
To quote: "The draft requirements will not be proposed for adoption by the National Council's membership in August. A later adoption will also have the benefit of allowing work on continued competence currently underway by another National Council committee to be completed and integrated into the uniform licensure requirements. As stated above, the National Council's membership remains vitally invested in the eventual uniformity of licensure requirements."
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SAMPLE LETTER TO COPY OR PRINT and mail/email/or fax to your state board of nursing.
BOARDS OF NURSING ONLINE
Arizona,Arkansas, Illinois,Kansas, Maryland, Missouri, New Hampshire, New York,Ohio, Texas, Utah, Vermont, Virginia. Wisconsin
Other State Licensing Boards
The summer season means for many school vacations for the kids, aromatic barbecues, pleasant picnics and good old fashioned family togetherness. For many advice and after-hour call centers, summer can mean a lower call volume than what is experienced during the cold and flu winter season.
The usual types of calls or symptoms often change during the summer months and may involve the problem of prolonged sun, heat and humidity exposure. Coupled with strenous exercise the sun can be expecially hazardous to our patients health.
You can Test Your Sun Smarts with this creative online summer survival test sponsored by HomeArts. Although geared toward the consumer rather than nurses, health professionals will be entertained by this approach to online health information.
Test Your Sun Smarts -->http://homearts.com/depts/relat/07safeb8.htm
The Children's Hospital of Wisconsin offers web-based information on the prevention of sunburn in children. This includes keeping infants under 6 months old out of the sun, using a sunscreen with an SPF factor of 15 or greater, and wearing hats with a visor.
Sunburn and Children -->http://www.chwpr.org/sunburn.html
Virigina Tech University Student Health Services presents wonderful online information explaining sun damage -- from ultraviolet rays to how to pick out the best sunglasses. Other topics include: Differences in tanning cremes and sunblockers, skin self-care, tanning beds and lights.
VTU Student Health Services -->http://healthed2.shs.vt.edu/sun.html
The American Academy of Orthopedic Surgeons offer good advice on heat injuries. This downloadable text file helps you to differentiate between heat cramps, heat exhaustion and heat stroke along with prevention techniques.
Heat Inury --> http://www.aaos.org/wordhtml/pat_educ/heatinju.htm
Even your dog can be healthy and safe during the summer heat by following some basic tips from the Animal Welfare League of Alexandria. A cool shelter, plenty of water, a limiting exercise can keep your dog cool and happy.
Pet Safety -->http://www.adoptapet.com/alexandria/health.html
Surviving Summer is the name of this well written web page subtitled How to handle beestings, sunburn and other summer bummers. Sponsored by the Group Health Cooperative, the nation's largest member-governed healthcare organization, which is located in the Northwest US. Of interest, the GHC offers a Consulting Nurse Service to members.
Surviving Summer -->http://www.ghc.org/nwhealth/julaug96/survive.html
Dear TNT
I am a big reader of your Telezine, and really have been impressed. Your webpages have helped me with the transition from ICU to Telephone Triage.
I currently am the Lead Nurse in a fairly new rural Telephone Triage Center that has been a little slow on the call volume. We are commited to the program, and looking at ways to improve our service.
I am attempting to collect data to assist in the growth process. Anyone you could forward the survey to would greatly be appreciated. I would greatly appreciate for any nurse that does telephone triage to complete the survey that follows and forward it back to me.
For all those that reply, I will e-mail them the completed survey result analysis. I will also forward a copy to you for the Telezine.
---------------Start Survey here----------------
Survey:
---------------End Survey here----------
Please have the completed survey returned by AUGUST 31, 1997 via my EMAIL address at hallison@texoma.net. Compiling of results will start then, with the results sent to all that reply by August 31, 1997.
Thanks again for taking your time to input into an infant call center's growth.
Henry Allison RN
email to:hallison@texoma.net
[EDITORS NOTE: I strongly encourage you to participate in this survey!
Henry has extended his original July 31st date solely for the readers of TNT and has already gathered information from 35 different sources. If you have difficulty in doing a copy/paste of information from this ezine to your electronic mail program, simply send a quick email to Henry that you'd like your own copy of the survey and he'll send you one. PARTICIPATE.]
The response from TNT readers to a NEW nursing organization devoted entirely to Telephone Nursing has been wonderful. Do you want to be part of a group of nurses currently working on forming such a specialty organization? This would be an organization that IS NOT part of any existing nursing organization. Instead would be an effort to recognize that telephone nursing occurs in many different specialties but is united in its approach: using the telephone as a primary tool in health care education and advice by nurses.
If you have an interest in either working
with or joining such an organization, there is now a special e-mail address
JUST for that correspondence.
Send your name and level of interest to
ITNA@katsden.com
Please do not expect an immediate reply to your query. Your name will be kept in a database for future contact.
Many of us involved in this new organization plan to meet at the WASHINGTON DC conference planned by Contemporary Forums listed below on November 6-8th. Information will be available *at the conference* as to the exact meeting place. It will be on Friday Nov. 7th at 5:30pm, right after the conference adjourns for the day, in the same hotel. Please, if you are attending this conference and want to be included in the preparation for the meeting, include that in your e-mail to me.
I look forward to hearing from all of you! ...Editor TNT
Contemporary Forums
- Telephone Triage Conferences
When/Where:
September 28-30, 1997 in Seattle WA
October 12-14, 1997 in St. Louis, MO
November 6-8, 1997 in Washington DC
Intended audience: all telephone triage
practitioners, no matter what the setting,HMO, Home Health, ED, Public
Health, Community clinic or office. For nurse entrepreneurs, system managers
and administrators
For more information
contact: Contemporary Forums at (510) 828-7100
URL at: http://www.cforums.com
*****THIS IS A
CONFERENCE THAT IS NOT TO BE MISSED
BY ANY TELEPHONE
NURSES! THE BEST!**** [Editor's comment]
IBC USA is
proud to announce the following 2-day conference:
Facilitate Communication
Between Patient, Provider and Payor through Interactive Health Care Web
Sites
When: July 24-25, 1997
Where: Washington, DC
What: In-Depth Coverage from: United
HealthCare Corp, Kaiser Permanente, PacifiCare of Oregon, InteliHealth,
SmithiKline Beecham Pharmaceutical, Greenstone Healthcare Solution on the
following topics:
*Interpreting visitor stats to measure
ROI of internet marketing
*Analyzing legal status of conducting
business in Cyberspace
*Collect and analyze risk factors through
on-line assessment
*Employ information from state and federal
regulatory agencies
Plus, an exclusive pre-conference workshop
- "Using the Intranet to Facilitate Information Flow in a Health Care Environment"
For more information,
visit http://www.ibcusa.com/conf/healthnet
Or for a full conference brochure, contact
Jonathan Gerson at: jgerson@ibcusa.com
[Some conference information is obtained directly from the Web. The editor of TNT is not responsible for any errors related to conference detail and all information should be confirmed with conference directors]
Clinical Care Options for HIV has been recently released. It is a new draft of Federal Guidelines for the use of antiretroviral agents in HIV infected adults and adolescents. This hyperlinked report is important reading for all nurses but especially those involved in HIV/AIDS care.
Clinical Care Options/HIV -->http://www.healthcg.com/nihreport
Holy Gumbo
Louisiana cooking is truly a cultural heritage of the US. The Creole and Cajun Recipe Page starts with the following quote from Mark Twain: "New Orleans food is as delicious as the less criminal forms of sin." This wonderful subset of the Gumbo Pages introduces you to the basics and beyond of this special style of cooking.
Creole and Cajun Recipe Page --> http://www.gumbopages.com/recipe-page.html
Women Webbed
Random websurfing can have its delightful moments when your click brings you to a novel and creative site.
The women-networking.com page is a premier online service for women who work. New information is published daily with features related to entertainment, virtual vacations, and links to visit during your coffee breaks. Check it out
Women-networking.com --> http://www.women-networking.com
Since no telephone nursing stories were shared this month, the following was snagged directly from the Internet.
An elderly gentlemen went to the doctor for a physical. After examining the man, the doctor said "I think you are alright, but just the same before you leave I would like a urine sample, a stool sample, and a semen sample."
The man, who was a little hard of hearing, turned to his wife and said "What did the doctor say?"
His wife quickly replied "He wants your shorts!!!!!"
== WASHINGTON STATE ==
Careline Nurse
Geographic Location: Northwest (Tacoma, WA)
General Information: This position is a part of Human Resources (CER)
(Employee Benefits) This is a part-time, exempt position.
Background: This part time position provides patient education,
utilization review services, and case management for eligible
employee/retirees and their dependents. This is a relief/float position
with a variable daytime schedule, 32-40 hours/week.
Key Functions: Review all aspects of hospital stays and major outpatient
procedures. Provide education to assist patients in receiving quality
health care. Work within the benefits plan to manage major cases. Act as
clinical consultant to Employee Benefits Department.
Requirements: Five plus years varied and recent RN experience. Must be a
currently licensed, registered nurse (RN). Possess current clinical
knowledge in all areas of inpatient and outpatient care. Knowledge of
how to access and move within the health care system and to influence
others. General familiarity with rehabilitation programs, home health
services and other community health resources. Team-oriented. Excellent
communication and organizational skills. Good problem-solving skills,
high tolerance for ambiguity. Able to function independently and manage
multiple priorities. Excellent listening ability, empathy and judgment
(especially on the telephone). Computer literacy required. Successful
completion of a pre-employment substance abuse test (negative result) is
required for external candidates.
Desire: Knowledge and/or experience of
the utilization review process. Knowledge of insurance terminology,
Medicare, coordination of benefits. Ability to use ICD9, CPT and PAS
norm books, as well as clinical protocols and clinical evaluation
criteria. Analytical skills, including basic knowledge of statistics.
Familiarity with Weyerhaeuser's health benefits programs. A
pre-employment drug screen (negative results) will be required as
a condition of employment.
Contact: Send scannable resume/cover letter and salary requirements to
Weyerhaeuser Staffing Resource Center, Ad#CO97-0000036. CCB 5D7,
Tacoma, WA 98477-0001 by Monday, 8/4/97.
E-mail in ASCII text (not as an attachment) to: resume@wdni.com
*********
[EDITORS NOTE: All employment opportunities have been submitted directly to the Editor of TNT for inclusion. Please check with the manager or recruiter listed for all details and job requirements. TNT takes no responsibility for verifying information submitted. Applicants must deal directly with listed "reply to" or inquiry contacts. There is no fee charged for posting employment desired or available, but submissions must be of an acceptable size and format for the ezine.]
August
1996 - Introductory Issue
September
1996 - Featuring: OB Telephone Nursing
October
1996 - Hospice and Telephone Nursing
November
1996 - Telephone Nursing and Seniors
December
1996 - Special Holiday Issue
January
1997 - New Year, New Approaches [Telenursing/Telemedicine]
February
1997 - Spring Ahead!
March
1997 - Marching Forward
April/May
1997 - Celebration of Nursing
June/July
1997 - Men's Health
The Web Page
The Telephone Triage Nursing Web Site is at http://www.katsden.com/telenurse/index.html