March Contributing Editors
Tony Dombroski BSN RN
Nurseone@nurseone.com
and
Valerie G.A. Grossman, RN
Valerie210@aol.com
[Best viewed with Netscape Navigator or Microsoft Internet Explorer]
Our entry into March is a forerunner of spring...a time when we start to wave winter good-bye and watch warmer weather appear. The coming of spring, marked by the passage of the Sun from the southern to the northern hemisphere of the sky, is accompanied by awakening life around us, a yearly "miracle" we all enjoy. Telenurses gratefully wave flu and cold season adios!
Two times each year the Sun crosses the celestial equator resulting in day and night being of equal length, or an equinox. The first day of spring officially occurs on the vernal equinox, which in 1997 occurs on March 20th. Several special days are celebrated during March and April, including St. Patrick's Day, Easter, Passover, the Flower Festival, and Earth Day. Enough to keep us all busy.
Spring cleaning is also a yearly ritual for some, a time of renewal and a refocus of energies. Whether your cleaning is physical or spiritual, it offers a good time to rethink old habits, discard those that are not working, and march forward with renewed energy.
By Tony Dombroski BSN RN, Contributing Editor
The wonder of my job is that after fifteen years of having people tell me the intimate details of noted intestinal effluents I haven't lost an ounce of enthusiasm for these details. No doubt my social calendar reflects this trait since a dinner invitation is as frequent as a tall tree on the tundra.
Nonetheless, today I will limit my comments to the stated problem, "black stools". Those of us in the business know that this complaint occasionally means that the patient is bleeding internally. That is, blood is being coagulated by, lets say, stomach acid and produces the noted color and therefore the inquiry.
Not every person that presents with the complaint of black stool is bleeding to death. So what else can it be? Gee, a variety of food products and medicines produce this result. Iron supplement pills, vitamins with iron, Pepto Bismol (bismuth subsalycilate), charcoal tabs (for gas or as the universal antidote) are among some of the pills that can cause black stool. The food list is much longer and in no way complete. Organ meats (bloody, esp. spleen stuffed with kasha), beets (usually red stool), spinach (iron), licorice, some fruits (blueberries), and some purple foods come through color intact.
The hysteria produced when a person believes they are bleeding internally is not the topic of today's discourse. But rather a horde of seething greenish short individuals that are about during this time of year screaming for you to purchase and consume another suspicious foodstuff that can produce the symptom in question. Leprechauns? No, these are Girl Scouts. It has been noted recently in my practice as well as in the past that after consuming a quantity of 'chocolate sandwich cookies' a person may present with the complaint of black stool. Exhaustive elicitation of dietary history in patients presenting with dark stool should include information regarding consumption of Hydrox or Oreos or Mint Chocolate or Mystic Mints. Need I say, "Got milk?"
To Quote Dr. S. Sulkes of Monroe County Developmental Disabilities Office in a letter to the New England Journal of Medicine, Jan. 5, 1984, (do references get more obscure?) "To this list should be added the colorings present in chocolate sandwich cookies". The author and several volunteers noted the presence of black stools 18-24 hours after eating 225 to 445 grams of cookies. 30 grams equal one ounce, so 240 grams is about 8 ounces or roughly half of a one pound box. (Who can eat less than half a box?) This was not noted after ingestion of other types of cookies (research-boring? never). He continues, "This phenomenon may be on the increase because of shifts in U.S. dietary habits". The lovable green scouts, found at the door of every retail establishment at this time of year, create a seasonal shift in our dietary habits. I'm not suggesting you change your choice of dietary indiscretion at this time of year but please include "cookie induced pseudomelena" or "Hydrox fecalis"(as Dr. Sulkes call it) in your differential diagnosis.
I might suggest that you go out now and buy a few boxes to test the principle yourself.
[EDITORS NOTE: This article was originally published in Surfing Medicine the Journal of the Surfers Medical Association July '95. Surfing Medicine is published twice a year by and for the Surfer's Medical Assocation. P.O. Box 1210, Aptos, CA 95001-1210. Editor Kahuna Mark Renneker. Reprinted with permission of the author. ]
In the February issue of TNT, Ruth Johnson shared her experience as a Internet Resource Nurse in perinatal health at the Lifestart MultiMedia web page.
The following letter(s) were received in connection with that article, which TNT feels is of merit to be featured in this issue.
====Letter from a Reader======
Dear TNT
I am curious that none of Ruth Johnson's nor the LifeStart Multimedia Corp.'s credentials were listed with the article. I do feel that if the British Columbia Nurses Association have accepted her she must have some credentials, but if one goes to her web page it is hard to figure out exactly how Ruth became an expert. Saying one has hours of experience is not the same thing as saying one has "work experience" nor that one belongs to an accredited organization of Perinatal Nurses.
This only brings out one of my concerns about gathering health information over the web. How does the consumer know that the person answering the questions will give them accurate and responsible information? I feel it is up to the provider of the information to offer his/her credentials at the onset so there is no potential for concern.
Cara Zeidman, MSN, RN
acenter@stny.lrun.com
Community Health Information Network System Supervisor
====Ruth's Response======
Dear TNT
I appreciated Cara's comments on the "On Duty...On Line" article and the Lifestart Multimedia website. I also share her concerns about consumers gathering appropriate health information via the internet. This is one of the MAJOR motivations behind my practice as an Internet Resource Nurse.
Two unfortunate things happened here.
1. Cara misread the information.
I readily agree with her that 3000 hours of experience is very limited and does not make one an expert. The following is what was actually written on the web page....
Ruth is a Registered Nurse who's heart beats in the body of the real life nurse Ruth Johnson but who's mind is a collection of the most advanced information of the professional nurses, midwives, childbirth educators, doula's and doctors from around the world. Ruth has over 3,000 YEARS of experience in perinatal nursing and has basically seen and done it all.
This insert was put in so that people who contact the nurse will not be expecting MY personal opinions but what is generally accepted as appropriate health practises from sound medical research. While I am the nurse typing the answer, I am not always the person that answered the question.
The person Ruth Johnson has only had 20 years of experience in Perinatal Nursing throughout various hospitals and communities in British Columbia. Beyond my basic training I have taken a post basic "advanced practice" course in perinatal nursing. I do my best to keep up-to-date in my defined area of professional expertise.
The Virtual Nurse "RUTH" relies on information and support from all the resources available to nurses in our day. I am not a doctor and I do not give out medical advise. In fact I rarely give out any advice at all. As the internet resource nurse I see my role as pointing out the resources available to the person in their community.
For example, if some one asks me if I think bottle feeding is just as good as breast feeding, I don't say yes or no. I also don't tell them what I did personally. I just point them to the current literature available and the resources that would be helpful in making this decision. I try help them to clarify their concerns and feelings during the decision making process.
2. The page listing my credentials (including a picture of me) is not available for viewing yet as our webmaster is very busy juggling the priorities of everyone involved. The plan for the website is to include an informational note about all the great people associated with Lifestart Multimedia including the nurse, the production coordinator, the office manager, the CEO and the medical/professional advisory team.
We are striving for a professional looking, informative website and like all things with a focus on QUALITY it takes time. I trust this will clarify the concerns Cara has mentioned in her letter.
Ruth R.N.
rjohnson@bc.sympatico.ca
Internet Resource Nurse
====Editor Response======
Both letters received regarding the article on Internet Nursing raise some important issues, and the letters from both Cara and Ruth make good points. TNT readers are asked to share their ideas and opinions on the following questions.
One not-to-be-missed Internet site dealing with a code of conduct for health on the net is the Health on the Net Foundation or HON. This international non-profit organization headquartered in Geneva Switzerland actively promotes effective Internet use by health professionals. Their HON Code of Conduct was issued in response to concerns by members of the Net community, regarding the varying quality of medical and
health information currently available on the World-Wide Web.
You can read their code of conduct at: http://www.hon.ch/Conduct.html
As nurses we know our workplaces are changing, and that the virtual world offers intriguing possibilities to help better educate our patients and communities. As health professionals, we can all assist in making the Internet a safer place for ourselves, consumers and patients by speaking out when we have questions about web-based health information, and adhering to the highest standards of ethical health practice on the Internet.
K. Webster RN BSN
webster@cyberspy.com
Editor - Telephone Nursing Telezine
By Valerie G.A. Grossman RN, Contributing Editor
Where'd they go? Did you see them leave? Are they gone forever? How'd that happen anyway?
It wasn't too long ago where we could finish our basic training as registered nurses, find a job, and be comfy-cozy for an eternity. If we felt like it, perhaps we'd pass the certification exam for our specialty area or tinker at some continuing education to combat our boredom (or to use a benefit as offered by our facility).
Life in nursing has changed forever. Somewhere over the past decade, the expectations for nurses have changed dramatically ... and changed permanently. With bedside RNs being replaced by non-licensed personnel at an alarming rate, the RN of today has a new and constant obligation. We must continually look at ourselves, and determine how we can make ourselves more marketable in today's health care arena.
When nursing lay-offs headline local papers and the classified sections are scarce for open nursing positions, the task of obtaining employment becomes a nightmarish battle for today's RN. We must settle for less-than-our-favorite area of work or hours that negatively impact on our personal lives.
Nurses have to make the very personal choice of accepting the victim role in this aggressive environment or choosing instead to win back control of their career. I believe that this process will naturally divide those nurses who are committed to our profession from those who merely use their license as a way of earning an income. In the future, those who use nursing solely as a way of earning a living ... will find themselves earning an income as something other than a nurse.
For those of who are committed to providing the best quality patient care within our means, we must understand that it will take a daily commitment to our patients and to our own future. How do we stay firmly planted in our health care situations? There is no absolute ... but there are many things that we can do to make ourselves very difficult to replace.
We must first find our own self-actualization ... to look inside, and see who we are and how we deal with our external stressors. Rigidity in beliefs has to become a thing of the past, and be replaced with flexibility. We have to accept that change has occurred, is occurring, and will continue to occur. For those nurses who rebel against the changes in our profession, they will soon find themselves in a different profession. There is no room for "the way we've always done it" ... we have to be ready to find a new and better way of performing our expertise.
Our outlook has to become global. Looking out for number one is a thing of the past. Each and every RN has to step back and look at the global picture. It is no longer one unit against another ... we have to band together as a team and decide together what is best for the patients, the staff, or our facility. Professionalism has to be the for-front of everything we do. Acuity is higher everywhere ... inpatient, outpatient, private doctor's offices. We can no longer afford to risk wasting one moment of our time or the patient's time. Our patient's have choices ... and if we don't deliver professional service each and every time we have the opportunity ... our patient has the choice to go elsewhere for their health care. With health care dollars drying up ... competition is going to continue to become fierce.
We have to actively market to our patients every opportunity we have. We will become similar to Disney's way of doing business ... to make each patient (and family member!) feel vitally important every time we interact with them. We have to control our every move and remember that just because we are behind the nurse's station, we are not shielded from the public's eye. We are "on stage" every moment of our shift ... and need to present a constant professional appearance to our public.
Our performance becomes a vital issue every time we make a move. We have to maintain a global awareness of our profession, and tailor our total performance to precision excellence. Good enough is NOT good enough. We must use our supplies sparingly and remember to charge for them when we use them. No longer can we use those disposable blue sterile bowls for individual servings of popcorn for the staff ... the repeated expense of that habit becomes a major expense for the facility. Higher acuity leaves less room for human error ... we do 2,000 right things every shift we work ... but it takes just one error that could potentially kill our patient.
Continuing education is a vital link to our security in the future. The more educated we become, the greater our ability to flex with the changing times. Continuing education is in front of our every turn. No longer are CPR and fire safety acceptable for our annual inservice record. Many nursing specialty areas now require Advanced Cardiac Life Support (ACLS) and/or Pediatric Advanced Life Support (PALS). Organizations offer their own concentrations of continuing education such as the Emergency Nurses Association and WholeNurse. Companies offer an array of continuing education courses from one day seminars on an endless sea of topics, to on-line companies that offer inservices on a variety of topics such as Health Interactive.
Even colleges are available on-line now or offer distant learning opportunities. Accredited colleges in Iowa and California offer BSN programs through directed independent learning, and some are even branching out into MS programs. For those nurses interested in business degrees, there are numerous on-line or long distant independent programs to earn an MBA.
Tomorrow's nurse is going to be confident and firmly planted in their educational background. We are going to lead the health care of this country through some very difficult times that are ahead of us. When push comes to shove ... the foundation of health care has always been built on the strength of our nurses. Our roads ahead won't be easy or predictable, but we will be able to meet and exceed the challenge put in front of us. After all ... our country depends on us.
The ENA website is at: http:/www.ena.org/
WholeNurse CE offering at: http://virtualnurse.com/holistic_ce/directions.html
Health Interactive URL: http://home.earthlink.net/~dendrob/msioindex.html
Eye On Patients is good reading for all nurses, with special interest for telenurses as the use of triage in healthcare is commented upon twice within the results. The first comment reads:
However, it's important to realize when you need to talk to a professional. Many hospitals, clinics, health plans or employers offer telephone services (such as "Ask-a-Nurse" hotlines) that give advice about what to do if you are not feeling well.
The second reference to triage, not specific to nursing and not complimentary, is in the Appendix section:
Access. Patients want access to care and they are frustrated by the barriers they often encounter -- whether because of telephone triage or voice mail systems; scheduling difficulties; zealous "gatekeepers"; or restrictions imposed by managed care or insurance coverage.
Also found at the AHPI website was a gem of an column on healthcare by Mary Grayson. Check out the one dated Dec 5, 1995 -- entitled "Ask A Nurse".
Ten pro-nursing points for Mary. Do read it.
The American Hospital Publishing site can be found at: http://www.AmHPI.com/
This year in the US, National Nurses Week is May 6-12 and has the theme
All nurses should celebrate our profession, including telenurses. Start planning now for your special events, and feel free to share your best ideas with TNT for the April issue.
Dear TNT
I figured you were out there somewhere! I'm BS RN with CDE/CETN specialties. Seems like a perfect solution to reaching more patients! Are there any other CDE nurses or CETN's out there who are currently telenurses?
Signed:
Myra
e-mail: myra@i-55.com
Dear TNT
We are a new service which is home based and provides telephone triage services for over 75 local pediatricians. As with any new program, we are ironing out some wrinkles and would like input from others who may have run into similar situations.
I look forward to hearing from other services (adult or peds) who have had similar situations, and would like to network with any/all ENA members who are performing telephone triage.
Thank you.
Valerie Grossman
Community Pediatric Telephone Triage
Rochester, NY
e-mail: Valerie210@aol.com
Dear TNT
I have been a Telephone Advice Nurse for approximately 14 years - mostly pediatrics, but in past 2-3 years, regional advice for a large HMO - we have recently (past 2 yrs) moved to a large call center. Many of us are having a very hard time dealing with the impersonal atmosphere, and a reader board that shows us how many calls are in cue at any one time. We have very good written protocols to work from, and most of us have many years in nursing. However, we feel very left out of the mainstream of patient care, due the call center atmosphere. Prior to this, we worked out of the hospital, with MD access readily available.
Any one in the same situation?
Signed:
Margaret
e-mail: finleymw@juno.com
Dear TNT,
I was so excited when I found your magazine on the Web!! I have been doing telephone triage for 10 years and developed the physician referral and health information service here at Baptist/St. Vincent's Health System 10 years ago. I have been in nursing for 17 years with a certification in gerontology and nephrology. Our service also maintains a web site and an "ask the healthlink nurse" section for medical questions which I answer on-line.
Thank you again for a wonderful publication. Keep up the good work
Cynthia J. Wade RN,C
e-mail: cwade@jax-inter.net
Coordinator/Healthlink
Baptist/St. Vincent's Health System
[Editor response:
The web site for Baptist/St. Vincent's Health System can be found at:
http://www.baptist-stvincents.com/.
Their E-mail HealthLink Nurse page is at: http://www.baptist-stvincents.com/hlmain.htm.
This site also features the ability to search for a physician referral via the Internet, plus a section entitled "Ask Doctor Joe". Please do visit this interesting web page, and leave e-mail to say "hi" to these HealthLink nurses!]
Dear TNT,
Just discovered your telezine, and I wanted to thank you for all your time and effort in compiling it. I am a medical transcription instructor, and my wife is a telephone triage nurse in Seattle. She also works a second job as staff development coordinator for a local hospital. She is so busy that I have to do her legwork on the Internet, downloading files.
Your articles look very informative for all medical professionals. Of particular interest to me is the concept of telecommuting, which transcriptionists are jumping into left and right. In fact, I've been recently contacted by a publisher about a book on home-based transcription!
I just wanted you to know your work is greatly appreciated.
Sincerely,
Keith A. Drake
e-mail: ekard@aol.com
[Keith is especially interested in hearing from other medical transcriptionists out there!]
Dear TNT:
As nurses, we owe it to our clients to offer the highest quality health care possible. As TT has "morphed" from a marketing tool to a clinical tool, has attention to quality kept pace? While WE may be committed to quality, we need to ask ourselves if vendors of TT products are as committed to ensuring this quality.
We use the algorithms (guidelines) to reach a disposition that we assume is "correct". Yet we need to ask how the software companies have determined this? Are they willing to share their override rates with us? Are they willing to share their evaluation techniques with us?
Would we be willing to accept assurances of "excellence" without any data to back this up in other areas of medical care? No!
The FDA has said that they are considering regulation of medical software products. The NCQA has discussed the notion of developing quality criteria for this software, as well. But, thus far no outside agencies have oversight of TT software, despite the fact that an estimated 75 million people are eligible for telephone triage.
Where are our voices, as nurses? We have always been advocates of quality care. Let's not be passive in our assumption of excellence. Let's ask TT software purveyors the hard questions, and insist upon continuous quality improvement of their products that guide our ability to offer our patients QUALITY CARE.
What you can do:
If you are interested in doing more, let's talk!
Signed,
Jane Mohler RN,CCRC,MPH
(520) 722-1970
E-mail: jmohler@md-inc.com
Dear TNT,
We have a question from the workplace. The noise in our area is very distracting. Out room is square with windows to the main clinic area on two sides. We have four stations which are not always in use. We usually just have two nurses on the phones at any given time, but on holidays we have three nurses and one PCR. The noise is bad enough with just two of us, so when we all get to yakking at once it is maddening.
We have two different kinds of head sets which are used with the lousy phones we have. One type has the over the ear piece that is a small speaker that just hangs there, the other type is the one ear foam covered ear piece. All the noise comes in the uncovered ear. With the hanging speaker the noise comes in around the speaker as well as the uncovered ear. We requested double ear muff head sets to try but they are very expensive.
So what we need is references to how to manage noise in a call center. Our arrangement does not have separate cubicles we work at a long desk which is on three walls of the room U shaped. Do you know of any data re: noise management? any data on how distractions like other conservations affect our ability to provide good nursing advice? We know we can only effect change with hard data and may not get results even then. Our manager has offered to supply us with foam ear plugs for the open ear, however I do not think that will be much help unless we are using the ear muff head set.
Re: TNT. I really enjoy reading it each month and make copies for us at work. Keep up the good work.
Signed:
Carol Duncan
e-mail: cduncan@olywa.net
[Editor's note: Watch for articles related to work environments and ergonomics in TNT!]
Carol Stock JD MN RN presents interactive one day workshops for telephone nurses. Carol is an attorney, adjunct professor at Seattle Pacific University, and a wonderful speaker -- in addition to having experience as a family nurse practitioner prior to her law practice. She will be presenting two different workshops during the next few months. See the following URL for dates and locations:
When: March, April and May 1997
http:/www.katsden.com/telenurse/confer.html
Contact: Carol Stock and Associates
POB 31114, Seattle WA 98103, phone/fax (206) 789-0909 PST
When: Thursday, April 17, 1997
When: May 3, 1997 Saturday 8:00-4:30
When: May 1-2, 1997
Dr. Hurdis Griffith, Dean of the College of Nursing at Rutgers, who will present the conference keynote presentation "Societal and Cultural Changes in the Digital Age: Implications for Nursing." Other speakers include Susan Newbold, Cathy Wasem, Dee McGonigle, and Diane Skiba.
The fee for attending the entire conference is $75; one-day registrations are available for $50/day. A discounted rate will be available for students.
For a list of other speakers and their topics, and more informationabout the conference, visit the web site:http://www.cee.umn.edu/pdcs/nursinfoage.html
When: July 11, 12 and 13, 1997
Where: Department of Health & Human Services, Washington DC
What: A one-day mini-conference on health-oriented online self-help networks. A conference for Hospital Webmasters and other Online Health Professionals.
Conference Coordinators: Mary Jo Deering Department of Health & Human Services, and Tom Ferguson, M.D., Author, Health Online, Senior Associate, Center for Clinical Computing, Boston
For more information contact:
Mary Jo Deering: MDeering@osophs.dhhs.gov or (202)260-2652
Who: Sponsored by The Children's Hospital After Hours Care Program Denver, CO 80218
Featured Speaker: Bart Schmitt, MD, Keynote Address "Office Telephone Triage: The Basics"
All inquiries for brochures should go to:
The Children's Hospital, Nursing Education/Conferences Department
Telephone: 303-861-6150 or 303-861-6123
Where: University of Minnesota, Minneapolis/St. Paul, Minnesota
What: A two-day conference will examine the application of information technology in nursing education and practice. Plenary, workshop, and poster presenters will address the ways technology is changing nursing education, research and practice into the 21st century.
For an e-mail request for a program brochure to: mgeronim@mail.cee.umn.edu
Where:Jackson Hole, Wyoming
What: The goal of the conference is to provide technologists with state of the art information regarding all aspects of breast imaging. Up to date information on MQSA requirements will be presented by the ACR and the FDA. Program content will include lectures such as Dorothy McGrath RT(R)(M), from Massachusetts General Hospital, hands-on training and informal question and answer sessions to address the issues encountered by mammography technologists. Lectures on breast ultrasound with hands-on and nuclear medicine imaging of the breast will be included this year. There will be 16 - 18 CEU's available at the conference.
The registration fee will be $229.
Contact: Sue Hamilton 307 739-7675 for more information or e-mail at shamilto@wyoming.com
URL is at: http://www.wyoming.com/~sjh/mammo97
[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]
The following letter was sent to the TNT editor:
An International Scientific Study is looking for candidates via the Web.
The Motherisk Program from The Hospital for Sick Children of Toronto innovates by searching through the Internet for participants in a International Scientific Study concerning nausea and vomiting during pregnancy (NVP). This study aims to better understand the consequences of NVP on the mother and her baby's health.
The address is : http;//www.mshealthline.org
We would greatly appreciate that you inform your readers of that address.
Now, we would like to present to you the work of the Motherisk team which could concern directly the people who goes on your site. The inception of The Motherisk Program at The Hospital for Sick Children in Toronto in 1985 was in response to numerous inquiries by pregnant and planning women and their health professionals regarding the safety of drugs, chemicals, environmental agents and infections during pregnancy and breastfeeding.
Since its creation The Motherisk Team has counseled over 50 000 women, their families and health professionals. Follow-up of the outcome of these pregnancies has created the largest prospective database available today worldwide. At present time we counsel over 100 cases daily from all over Canada, as well as the United States. With 200 scientific papers and 7 medical texts published in the area of maternal-fetal toxicology, Motherisk is the leading clinical and research group in this field.
We are entering the second decade of Motherisk tackling important research questions such as the risks of binge drinking during pregnancy, child development after maternal cocaine use and the safety of antidepressant medications. In the clinical arena, novel methods to supplement women with folic acid early enough in pregnancy and thus preventing neural tube defects appear to be a top priority. Of similar magnitude is our ongoing battle to prevent unjustified terminations of otherwise wanted pregnancies by women who were misinformed about teratogenic risks after use of nonteratogenic agents. With scores of new medicinal drugs entering the market yearly and with more than half of all pregnancies unplanned, it will be crucial to continue and augment the clinical work and the research efforts of Motherisk. These will ensure optimal drug therapy for pregnant women while protecting their unborn babies.
For more information on our latest study, please don't hesitate to go on our web page at:
http://www.mshealthline.org
or contact the communication agents for the Motherisk Program:
Patricia Vandal or Martin Côté by E-mail: momrisk@total.net
or by phone 1-800-977-6362
WOW for Women
The Women Online WorldWide website celebrates the spirit of womankind and provides a variety of ways to participate via the Internet. A live chat area using IRC (internet relay chat) technology, web-based message boards on countless topics, a monthly webzine named Tapestry, an e-mail newsletter, a calendar of events, and more -- makes this website the perfect stopping place for both women and men interested in expanding their vision and horizons.
The URL is at: http://www.wowwomen.com
Comet Tale
While some of us were entertained by watching Comet Hyakutake last spring, this year Comet Hale-Bopp may be viewable where you live between March 26 - April 12, 1997. Some predictions say the comet won't return to this area of our solar system again for 2379 years -- as it takes several thousand years for Hale-Bopp to orbit our Sun. Contact your closest planetarium to see if they're having a star-party for this event! While on the Internet, several sites focus in on this comet's tale.
NASA's Comet Observation page: http://encke.jpl.nasa.gov:80/
Hansen Plantetarium [Utah] Hale-Bopp page: http://www.utah.edu/Planetarium/HaleBopp.html
CNN's Hale-Bopp page: http://www.cnn.com/TECH/9702/hale.bopp.comet/index.html
Tighten that CribSheet
A cribsheet for the APA Publication Style is available via the Internet, including suggested ways to reference FTP, Gopher and World Wide Web pages. For those unaware, the APA style is a widely recognized standard for scientific writing. This site openly declares it is no substitute for obtaining your own version of the 368 page manual, and offers contact information on how to obtain the hardcopy version. In the meantime, it offers valuable summary information with rules and reference examples. The home site of the page is Psych Web, maintained by Russell A. Dewey, PhD. It is an award winning website of psychology-related information for students and teachers of psychology.
Psych Web's APA Publication Cribsheet: http://www.gasou.edu/psychweb/tipsheet/apacrib.htm
Psych Web's Main Page: http://www.gasou.edu/psychweb/psychweb.htm
Holiday Hunting
If you're going to be wearing the green on St Paddy's Day, you might want to drop by Lucky Leprechaun's Lane, a netland of magical mists, lucky leprechauns and plenty of green! If you want to have a hoppy Easter, bounce over to Easter on the Net, and bring the kiddos. For those more interested in the Jewish holidays, visit the Yom Tov - Pesach page, with information on the meaning of Passover. For a change of pace, check out an article entitled Happy Birthday, Baby Buddha! from a Unitarian Church sermon. And last, but not least, add Earth Day to your list of celebrations on March 20th (same as the vernal equinox). Peace and the care of Earth begin in the mind.
Lucky Leprechaun's Lane at: http://usacitylink.com/lucky
Easter on the Net at: http://www.holidays.net/easter/
Yom Tov - Pesach is at: http://www.torah.org/learning/yomtov/pesach.htm
Happy Birthday, Baby Buddha is at: http://www.arastar.net/org/vuu/jford/ss960414.htm
Earth Site for Earth Day is at: http://www.earthsite.org
I had to share one of our amusing calls today. As a little background, our health system has a weekly noon show that spotlights a physician and a disease process or new procedure. This week it was impotence. A female caller contacted us very excited. She had been "impudent" for years and had no sex drive. I tried to explain impotence to her and she just couldn't seem to comprehend what I was saying. She just kept repeating she had no sex drive. Finally, in a last ditch effort to get my point across I asked her "M'am, do you have a penis?". She gasped and said "no". I said "well, then you can't be impotent". I did eventually get her to agree to call her gynecologist for evaluation & treatment.
Submitted by C. Wade, e-mail: cwade@jax-inter.net
Informed Access Systems is an innovative health care management company specializing in telephone triage. We are rapidly expanding and have several positions open to qualified RNs interested in high quality patient care in a non-traditional setting. Our company offers career opportunities to nurses seeking a chance to excel and positively impact the health care delivery system. We value our nurses' diverse educational backgrounds, experiences, and collective dedication to offering progressive health care solutions. Flexible hours, opportunities for advancement, excellent benefits and competitive pay contribute to our progressive work environment.
Telephone Triage Coordinator, salaried position, for new Medical Call Center in Winfield IL, 27 miles west of downtown Chicago. Previous experience in telephone triage nursing preferred. Require current Illinois nursing license, BSN with three years recent clinical experience, preference to applicants with emergency, ambulatory care, pediatric or critical care experience. Should have experience in hiring, training staff, and functioning in a lead position. Personal computer and typing skills required. Knowledge of NHES software a plus. Responsibility for leadership to telephone triage RN staff by coordinating daily activities as well as responding to health related telephone inquiries.
The Children's Hospital of Philadelphia, the oldest hospital in the United States dedicated exclusively to pediatrics, is currently seeking Telephone Triage Nurses (RN) for our rapidly expanding call center. As an integral member of our multidisciplinary team, the professionals we seek will provide care for children from neonatal to 19 years of age using computerized treatment protocols. You will need to exercise excellent clinical judgement and be able to identify when additional consultation is necessary.
JOB TITLE:SUPERVISOR, PHYSICIAN REFERRAL SERVICE
Seeking an exciting nursing opportunity? Our downtown Seattle company is rapidly growing and we're seeking experienced nurses to join our dynamic nursing team! We combine the clinical expertise of RNs with state of the art telecommunications to provide health care information and options that educate consumers in making healthcare decisions. Come and thrive where your nursing skills re respected and appreciated!
Weyerhaeuser Company, a major forest products company headquartered in Federal Way, Washington maintains an in-house call center which provides employees and retirees with health care information and education. We are seeking a RN for a part-time float position to join our Careline Nurse team. The hours for the position will vary from 25-40/week. A benefits package will be included. This is a phone based program which includes utilization review, case management, & patient education. The position requires 5+ years varied & recent RN experience; current clinical knowledge; general familiarity with community health resources; excellent judgment, communication, organization, problem-solving & teaming skills; ability to manage multiple priorities. Computer literacy required.
Come and ski Utah while working for a busy and rapidly expanding 24 hour call center.
[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.]
Review Previous Issues of TNT
August 1996 - Introductory Issue
The Web Page
The Telephone Triage Nursing Web Site is at http://www.katsden.com/tnt/index.html
Submissions of interest to Telephone Nurses in all occupations and environments. Preferred material is from Registered Nurses, Physicians and other health care professionals currently involved in the specialty.
Require all submissions by the 10th of the month for next issue inclusion.
==Colorado==
We are seeking highly skilled RN's with:
* Colorado RN license in good standing
* Minimum 3 years recent clinical experience
* Superior communication skills
* Team player attitude
If you have a desire to work in a friendly environment, please send resume to:
Informed Access Systems, Inc., Attn: Nurse Recruiter, 310 Interlocken Parkway, Broomfield, CO 80021
Phone (303) 466-9500, FAX (303) 443-3909
==Florida, South West==
Call Center Executive Director: location is within South West Florida and responsibilities include managing a regional call center that processes incoming calls for several hospital systems and subsidaries. BS required and a MS is preferred. A knowledge of clinical systems and managed care are a must; as is a minimum of three years in managing a multi county and multi facility demand management call center. A familiarity with NHES software is a plus!.
Triage Nurses: Location in South West Florida. A minimum of two years nursing, triage, emergency room, or physician office experience is required. In addition, a BSN is preferred but not required. Experience
in triage, medical sales, marketing or telemarketing is a definite plus. Nursing Triage Supervisor: BSN is a plus and a minimum of three years ( 5 years preferred ) experience is required. Location in South West Florida. Familarity with NHES software and call center training is a
definite plus.
Send all responses to: Marketing Consultant, 2920 Chancery Lane, Clearwater, Fl. 34619. Please include present salary and availability for interviews, and relocation preferences.
==Illinois==
Inquires to: Mary McDonough, voice (630) 682-1600 X2237 or fax (630) 260-2652
==Pennsylvania==
Positions include part time and per diem status. Qualified candidates must have PA RN license, a minimum of 3 years of pediatric experience and be a graduate of an NLN accredited school of nursing. Excellent verbal, written and telephone communication skills are required. Keyboarding skills preferred.
For more information please contact Maggie Tetreault, RN, Program
Manager at 215-590-5685 or e-mail: tetreault@email.chop.edu
==Pennsylvania==
Nurses to help us expand to 24 hours!!...
Brandywine Hospital is currently seeking nurses with sound clinical judgement and excellent communication skills to be a part of our community phone service. "THE PROFESSIONALS". Qualified candidates must possess an current PA RN license, plus a minimum of 3 years of acute care experience. The following schedules are available : (weekend rotation required): FT/PT 11PM - 7AM, PT 5 - 11P.
Brandywine Hospital offers an excellent salary, excellent benefits for full-time, and the chance to join a personal and professional working environment. Interested candidates please call:
Employment Coordinator at: (610) 383-8234 or send resume to:
Brandywine Hospital & Trauma Center , 201 Reeceville Rd, Coatesville, PA 19320-1536.
==Texas==
JOB ORDER NUMBER: UCHOTX01
SALARY RANGE: $40,000 - $50,000 / ANNUM
WORKSITE: HOUSTON TX
JOB STATUS: FULL-TIME HIRE WITH BENEFITS
POSITION SUMMARY:
This position is for a healthcare professional who will provide specialized physician referral information to all callers needing additional information about member physicians and facilities for making appointments. The position requires a high degree of proficiency in simultaneous multiple task
operations and projects with self-initiated follow-through.
REQUIRED QUALIFICATIONS:
The ideal candidate will have a high degree of experience setting up and managing a physician referral call center and communicating with physicians and health plans. Associate’s or Bachelor’s degree required; advanced degree preferred. RN or LVN preferred, however, strong non-clinical or other clinical candidates with strong call center experience will be considered.
PREFERRED QUALIFICATIONS:
Advanced degree, RN or LVN licensure, Texas
Contact us for specific information on position responsibilities.
Reply to:
ScienStaff, Inc., 7007 Gulf Freeway, Suite 239, Houston, TX 77087, 713/640-1929
or e-mail: ssihouston@aol.com
==Washington State==
We are recruiting nurses who:
* Have a minimum of 5 years recent clinical experience with emphasis on
triage, med/surg, chronic disease, OB, and patient education
*have good computer and typing skills
*current WA license.
*Can work flexible schedules/shifts including eves/nocs/wknds.
*Possess excellent customer service skills
We offer competitive salary and benefits, shift/wknd diff, 40lK, stock options. FT/PT all shifts available. Non-smoking corporate environment, EOE If you are interested in learning more about this terrific opportunity and meet the qual's...
Send resume to CareWise/Nurse, 701 5th Ave. , Ste 2500, Seattle, WA 98104-7015 or fax (206) 479-1125
==Washington State==
DESIRE: Knowledge of UR process & insurance terminology; familiarity w/ ICD9 & CPT codes. Substance abuse test required. Please send resume and salary requirements for search # TTN97047, by 3/18/97 to one of the following:
E-mail Address: jenkinl@wdni.com
Fax:(206) 924-4151
Mailing Address: Weyerhaeuser Company. CCB 5D7. Tacoma, WA 98477-0001
Located in downtown Tacoma
==Utah==
IHC TeleHealth Services is part of Intermountain Health Care (IHC), which is widely known for its community based health information, triage/referral service. IHC TeleHealth Services has expanded into facilitating personal health management across the health care
continuum for IHC Health Plan members in Utah, Idaho and Wyoming, while maintaining
our community service line. IHC TeleHealth Services answers between 1100-1400 calls per
day.
We are currently hiring RNs for full and part time evening positions. Both these positions are benefit eligible. Minimum qualifications include a current Utah RN license with a minimum of 3 years high acuity nursing experience. Must enjoy
working with people on the telephone. Must be able to sit for extended periods of time and
talk while typing with few errors.
Send all inquires via E-mail to aajcall@ihc.com or call Jan at 801-978-4045.
Please include your name and phone numbers where you can be reached.
Can't Get Enough on Telephone Nursing?
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!
Next months topic:
Celebration of Nursing
WANTED!
The contents of The WEBster's Telephone Nursing Telezine MAY be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording in information storage or retrieval systems, provided that all mention to TNT is maintained, the file is shown in it's entirety, no modifications whatsoever are made, and educational use is intended. This includes the option to "mirror" this web site or store copies at another Internet location. The Editor does request notification of mirroring or storage by a webmaster at other Internet locations. Photographs, graphics or inline images are not be used seperately from the publication in which they are imbedded nor download/modified for seperate use. This publication may NOT be sold or used in commerical publications or ventures without specific permission of the Editor. Mention of the existence and location of this web site and ezine in a commerical venture is acceptable and encouraged.
is published on the Internet at:
http://www.katsden.com/tnt/index.html