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The response and professional interest in the startup of this telezine has been outstanding and somewhat overwhelming. A big thank you to all my Internet Nursing colleagues and friends for your support on this new venture!
Here are just a few of the letters and comments the Editor received since the first issue of TNT.
As soon as I found your website and newsletter I made copies (before I even read it all) for my co-workers. The first coworker wanted her own copy so I will keep you posted on comments. From what I've seen you have done a wonderful job--thanks so much.
Congratulations for your cutting edge effort.
Great concept of using the internet for reaching out to people....keep up the good work, Kathi.
Even tho I am not a triage professional - I find your website excellent!!! Format & writing style is exceptional... I will recommend the site to clients.. Thank you and good luck!!
Just want to congratulate you on the launch of your new 'zine. I'll include this info in a course I'll be teaching in '97.
As a new Editor, I fully realize that this ezine will only be as good as the submissions it receives, and I urge readers to consider sending material about their practice of Telephone Nursing.
Also since circulation of this ezine is based on the World Wide Web and not mailed (via U.S. mail aka snail mail), I ask Telephone Nurses to print a copy from their web browser and share it with other nurses not yet on the Internet that would find it interesting. Get the word out that Telephone Nurses are talking -- and not just on the phone.
Thank you for your support.
Dear TNT,
I am an OB nurse and graduate student at the University of Iowa. One of my clinical projects is to set up a follow-up phone system for postpartum mothers after discharge.
We currently plan to have a phone call made on day 5 and day 10 after delivery. We are in the process of setting this up and making specific protocols to follow in case problems are identified. Any ideas or advice would be greatly appreciated.
Signed
Renee61168@aol.com
[Readers who wish to offer assistance are encouraged to contact Renee personally]
Dear Renee
I think your request reminds us all that there are subspecialities within Telephone Nursing practice. So often telephone nursing is viewed only from the "triage" perspective and categoried as a generic "health line" rather than being viewed as encompassing many different areas of nursing and expertise. Outpatient case management or nursing health management is an exciting direction for Telephone Nursing.
In addition to any advice that TNT might offer, expect to receive some intriguing email from colleagues on the Internet.
You will most likely want a mix of protocols to deal with specific symptoms, along with texts for health information. Most organized call centers use a combination of these two, differentiating between a person with an actual symptom and another who wants information only. Your resources can be hardcopy (books, magazines, prewritten literature) or computerized -- and even a combination.
Although I'm sure you already have a long and thorough list, the following topics might be appropriate for starters:
Mother oriented
Postpartum depression
Episiotomy care
Breastfeeding
Bottle feeding and formula
Exercise
Vaginal bleeding or discharge
Leg discomfort
Intercourse and use of tampons
Contraception
Signs/symptoms of infections
Nutrition
Medication
Postpartum health checks
Baby and Family Oriented
Normal growth and development
Umbilical care
Routine newborn care
Well baby health checks
Immunizations
Diaper Rash
Crying
Siblings
Fathers, Family and Friends
There are many things to consider when setting up a telephone nursing program, and TNT offers the following snippets of advice.
Your will need to scrutinize the objectives your program to determine at what point it is best to refer the parent directly to their physician for the answers, especially if the mother or child has more than a routine problem or has a history of complex medical problems. And even if not a serious problem, how extensive will your symptom list be?
Decide on a standarized method to document your telephone nursing advice and health teaching. The importance of documentation needs to be conveyed to all who perform these calls.
In addition, you could (and should) do an assessment of both internal and community programs and have appropriate referral information available. Brochures on all your internal resources and programs might be available via your Marketing or Public Relations Department. Examples of community resources might include La Leche, Poison Control, the Health Department and even your local Suicide Crisis Line.
And while you are doing a community assessment, consider assembling materials related to the languages and cultural backgrounds of the families you expect to serve. These will be invaluable as educational tools when training nurses for your program.
Look for already established procedures in your organization on how to handle difficult issues like child abuse or confidentiality. Don't reinvent the wheel - use internal resources whenever available, from policies to handouts. Check and see if your Legal Department is available to assist you with questions related to telephone triage and nursing practice in your state. We hope they are!
Attend at least one seminar or conference on the topic. Not only do you gain valuable information, but you may be able network with other nurses doing the same type of program.
The Internet offers several resources that are especially relevant to your Obstetrical Telephone Nursing practice. One of the best that TNT could find was the MCN or the American Journal of Maternal/Child Nursing Online. This outstanding web-site offers electronic issues containing articles, editorials, research abstracts, and more.
The URL for their website is: http://www.ajn.org/mcn/
TNT found several articles in MCN related to the use of the telephone for postpartum education.
Home from the PICU: Are Parents Ready?
By Katherine N. Bent, Arlene Keeling, and Janet Routson
at URL: http://www.ajn.org/mcn/1996/6.3/m603080e.1t
Meeting the Challenge of Early Postpartum Discharge
By Laura Preston Barnes
at URL: http://www.ajn.org/mcn/1996/6.5/m605129e.1t
Meeting Parent's Postpartal Needs with a Telephone Information Line
By Ruta Valaitis, Kathy Tuff, and Lia Swanson
at URL: http://www.ajn.org/mcn/1996/6.3/m603090e.1t
INREACH - Linking Walk-Ins and Their Infants to Community-Based Care
By Judith Fry McComish, Lynn A. Lawlor, and Marilyn Poland Laken
at URL: http://www.ajn.org/mcn/1996/6.5/m605132e.1t
Short, Shorter, Shortest: Continuing to Improve the Hospital Stay for Mothers and Newborns
By Leslie A. McGregor
at URL: http://www.ajn.org/mcn/1996/6.7/m607191e.1t
Author Wants Your Short Wire
The author of the above Short, Shorter, Shortest article, Leslie McGregor RN MEd, also recently contacted TNT. Leslie is now a Practice Administrator at a multi-physician Infectious Disease and Internal Medicine practice in Virginia. The following is a message from Leslie to any interested Telephone Nursing practitioners who wish to respond.
Having come into the ambulatory care setting only in the last six months, I am finding RNs in our office expressing a great deal of dissatisfaction over the time spent doing telephone triage. This has come as such a surprise to me a I see this as challenging opportunity for RNs to participate in the case management process. Are any of you finding your nurses burned out, or disliking telephone triage? Is it a challenge for a practice administrator to keep RNs who to this function?
Also, what is the education and experience level of your staff doing telephone triage? I strongly believe that this responsibility belongs to the RN and not to LPNs or PCTs even if they have protocols. In the office setting in our area, the trend is to let your personal assessment of the staff person's skill level outweigh the importance of education and training. Are you using non-RNs to telephone triage and what does your nurse practice act state?
Direct replies to Leslie are strongly encouraged by TNT.
You can reach Leslie McGregor via email at: Lamsva@aol.com
Walk the Line -- to Denver
Another interesting site is advice from the well-known Barton D. Schmitt MD from Denver Children's Hospital [Colorado], whose pediatric triage algorithms are well-circulated in the Telephone Nursing community. Dr. Schmitt would certainly be wise enough NOT to share his email address with TNT, else he would never write any new guidelines.
While you can certainly track down some of his books in your medical library or bookstore, his excellent advice for postpartum care is featured on a web-site entitled Your Child's Health - First Weeks at Home: Getting Help at the Family Planet web site.
The URL is: http://family.starwave.com/experts/barton/ba053196.html
An interesting example of how the telephone can be used to assist mothers and families during the postpartum period is covered in an article entitled Mothers Can Find Help For Postpartum Blues Through New Hotline by Carmen M. Christie. This site is a feature of the Star-Gazette Online [Elmira, New York based] and describes an interesting Hotline concept. Schuyler Hospital in Montour Falls NY has a 24 hour free telephone hotline service designed to deal with postpartum stress and is grant-funded. The URL is: http://excal-ny.pathfinder.com:8080/Elmira/Main/News/Daily/Star-Gazette/96/9602/960208/partum.html
Diane Wink, EdD, RNC has a well-known web page called Resources for Nursing and Families. Her site includes links to grant information, academic organizations, online journals and more. Check out the section on Child and Family Health. When Diane isn't busy as a Undergraduate Program Coordinator for the Nursing Program at the University of Central Florida, she maintains a thorough and graphically-pleasing website.
The URL is: http://pegasus.cc.ucf.edu/~wink/home.html
Well Renee, TNT hopes you find this information helpful to your clinical project. It would be great if you kept us updated with your progress and challenges.
And please feel free to share this Telezine with your fellow students and educators.
[Fade in. TNT on soapbox]
The Internet offers nurses the opportunity for communication that surpasses all others -- and assists us in acquiring new strength in the rapidly changing health care environment.
Lets make it a point to ensure all nurses 'get connected'.
If you are a nurse that uses the Internet, work toward getting at least one nursing colleague or friend online.
To use a phrase [coined years ago by the TNT Editor]
[TNT off soapbox. Fade out]
Nurse Epidemiologist (RN, MPH, Doctoral Student in Epidemiology) doing Telephone Triage Health Outcomes Research looking for colleagues doing the same. Contact M.Jane Mohler at Medical Directions,Inc. Suite "A", Tucson, AZ, USA 85715
TNT reported last month on some exciting seminars focused on Telephone Triage scheduled at Florida locations by Carol Stock JD MN RN. In response to interest, here is more on Carol's schedule.
For those who missed last month's issue, these one-day seminars center on the legal aspects of Telephone Triage Nursing. Check in the August issue of TNT for the full detail.
If you would like a full brochure on the seminars, call Stock and Associates at (206) 789-0909
Date: Nov 7, 1996
Salt Lake Hilton
Salt Lake City, Utah
801-532-3344
Date: Nov 8, 1996
La Posada
Albuquerque, New Mexico
505-242-9090
Date: Nov 12, 1996
Red Lion's La Posada Resort
Scottsdale Arizona
602-952-0420
Date: Nov 13, 1996
The Buttes
Tempe Arizona
602-225-9000
Date: Dec 4, 1996
Tropicana Resort and Casino
Las Vega, Nevada
702-739-2222
Date: Dec 5, 1996
Reno Hilton
Reno, Nevada
702-789-2000
Gee Carol, if we send you some quarters, will you hit the slots for us?
Contemporary Forums is sponsoring Nursing Issues in Ambulatory Pediatrics on November 4-6, 1996 (preconference on the 3rd). This national conference held in New Orleans LA (US) is appropriate for Office, Clinic, School and Advanced Practice Nurses involved in Pediatrics.
Although not geared totally toward Telephone Nursing, Dr. Barton Schmitt will be speaking on Developing an Effective Triage Program. It has a good mix of MD and RN presenters on a wide-range of current pediatric ambulatory care topics.
For information on this conference, check out: http://www.cforums.com/370.htm
For more information call Contemporary Forums at (510) 828-7100
Tell them you heard about them from TNT!
The American Academy of Ambulatory Care Nursing or AAACN recently changed it's email address. If you wish to contact this organization in the future, please note it is now:
In addition, for those who submitted abstracts for presentations at the 1997 annual AAACN conference in Seattle, the notices of outcome are just a little behind and will be mailed in early September. Watch your mailboxes.
Thank you, Colleen Dunn for the update!
The American Nurses Association has created a spectacular page on the World Wide Web entitled Nursing World.
You can find everything here from the Nightingale pledge to their credentialing catalog (downloadable). This should be an important fuel stop along the Information SuperHighway for all nurses, whether ANA members or not. Do visit.
The URL is at: http://www.ana.org/
Critical Thinking - Cabled Thoughts?
It isn't a surprise for those involved in Telephone Nursing that critical thinking is a highly desirable skill, especially when performing complex nursing assessments. The California Academic Press has a thought-provoking site related specifically to this "skill and habit of mind".
The URL is at: http://www.calpress.com/index.html
Grants Womb on the Web
The National Institute of Health has an invaluable web site dedicated to Grants and Contracts. Their NIH Guide is searchable and includes RFA's (Requests for Applications), Program Announcements, and Notices. If your telephone nursing program is U.S. based and struggling for funding, check here for grant monies that just might be available for your project.
The URL is at: http://www.nih.gov/grants/
Galvanized Practitioners in Nursing
The American College of Nurse Practitioners ACNP is an organization that plans "to unite, galvanize and represent nurse practitioners across the nation to ensure a prevention-based health care system with NPs as essential health care providers." A good site for nurses at all practice levels to visit.
The URL is at: http://www.nurse.org/acnp/
Geeks...er...Computers in Nursing?
If you haven't seen a hardcopy of this magazine, you are missing out. And you don't have to be a serious nurse 'geek' to enjoy Computers in Nursing. Their online version lists nursing Web sites and Home Pages of nurses around the Internet, in addition to some other nice features.
The URL is at: http://www.edoc.com/cin/
A new symptom strikes in Tampa Bay - reported to an After-Hours Call Center:
"His limp noids are swollen."
[Submitted by Jeanne Perea RN from All Children's Hospital On-Call, St. Petersburg FL]
Yes Jeanne, we all know how difficult it is when those swollen noids go limp. -- Editor
You can reach Jeanne for humorous (or serious) discussions at: jperea@gte.net
The Editor Speaks Out!
Telephone Triage Nurses once had an identity crisis. When asked by a colleague or friend what my specialty was, I often hedged at an answer, especially if in a hurry. Explaining the role of a telephone nurse many years ago was not so easy. "Are you still a real nurse?" they would ask. "Don't you miss the patient contact?" another friend quipped. When exactly did I lose the contact I mused, handling the umteenth call for the evening -- a woman with a newly found breast lump in a panic as she waited for her morning appointment with a surgeon. Or the next call from an elderly man with chest pain, popping antacids and in complete denial he might be having a heart problem. Or even the panicked mother of a child who woke up with a barking cough.
Add to this formula the fact that many of us reported to Marketing Departments. Turf battles were still being fought as to whether it was acceptable for nurses to report directly to someone other than a Director of Nursing. Matrix organizations didn't exist. But Marketing had the dollars then, and many Nursing divisions were not keen on sanctioning nurses "on the phone". It was frustrating having proof that nurses all over the hospital were answering questions 'off the cuff' to community callers while we had protocols and documentation to support us. But telephone nursing did not get overwhelming and official support in the beginning from Nursing departments - although I am sure there were exceptions. Our internal nursing support came later. We had to prove ourselves.
Next in the strange formula, Physicians were sometimes resistant to the idea of telephone triage. Not all of them, sure. But enough to make the lives of Program Managers miserable at times. We spent days working on the physician 'buy in' plan. Some programs found the most effective approach to the most irritated physician was to have them come into the call center and 'plug in' and listen for a while. They invariably left, in my experience, with a positive frame of mind about telephone nursing. Somehow a few physicians came to the conclusion we were trying to make a medical diagnosis. Not! We had plenty to keep us busy using the good ol' nursing process -- with problem-based (symptom) assessments and appropriate intervention, thank you. And proud to use creative nursing skills in community education too.
Makes you wonder how we survived as a speciality at all. Good question. Some programs were mandated by Administration just to get them up and running. Visionary marketing execs knew it was the right direction. Other triage programs quickly got that magically elusive 'buy-in' from physicians, who suddenly became our champions. Planning departments skirmed in delight that they finally could show demographically who the hospital had as clients. And last, but not least, the public. They loved us. They thanked us. They wrote letters.
If the above scenario describes what you are going through now, perhaps you are located in an area of the United States not deeply penetrated by managed care initiatives. You can look forward to much easier times. What is the current trend? Telephone Nurisng programs that report usually to a Medical Director and/or Nursing Director, with direct or indirect (matrix) connections to the Nursing Division, Marketing division, and other departments in a healthcare system. They are nursing practice oriented programs with medically-approved guidelines, and are focused on quality nursing care, and track outcomes and satisfaction. They may use computerization as a tool to enhance practice, documentation, and tracking. Some are independent departments, others may be centered in Emergency Departments, Ambulatory or Physician clinics. They are accepted, desirable, golden programs. Physicians and Nursing Administration are our partners, advocates and champions.
Telephone Nursing is no longer the ugly stepchild. It's one of the hottest, up-and-coming nursing specialties out there. And with downsizing a current buzzword and reality, sometimes the perfect place for the best and the brightest of nursing to head toward. It integrates all the best pieces of nursing practice and theory into one wonderful specialty.
Don't I sometimes miss patient contact? I never lost it. I can hold my patient's hand over the phone -- the same way I am holding your attention here in cyberspace or on printed page. Does distance make it less real or important? You tell me.
NCC certified Registered Nurse with 23 years of inpatient and high risk OB/GYN experience seeks position in Telephone Nursing practice in upstate New York (US)
area. Contact Marie Capezzuti RNC at : drquinn@global2000.net Attn: Marie
All Children's Hospital in St Petersburg FL is seeking RN's for their telephone triage program which is currently
setting the clinical standard of excellence for pediatric services. This position offers RNs the opportunity to manage
after hour pediatrician office calls providing education, information, guidance, emotional support, and counseling.
For more information contact: Wendy Smith RN, Nurse Recruiter at 813-892-8222. Resumes may be sent to All
Children's Hospital, Human Resources, 500 6th Street South, POB 31020, St Petersburg FL 33731-8920.
Review Previous Issues of TNT
The Web Page
Go to The Telephone Triage Web Site at http://www.katsden.com/telenurse/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 speciality.
Require all submissions by November 10th for next issue.
Employment Desired
Hard to find them better!
Can't Get Enough on Telephone Nursing?
WANTED!
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