Telephonic nursing has drastically changed over the past 2 decades. Nurses used to be primarily responsible for discussing lab results, medication refill needs, and how a patient might be able to care for a minor illness at home. Nowadays, nurses are responsible for triaging patient needs and often become an initial step to a patient’s healthcare. Patients may use telephonic nursing as a way to determine if they are sick enough to go to the doctor or if they really do need to be seen in an ER setting. Telephonic nurses also need to build a report with patients for them to open up and discuss their symptoms in detail for a nurse to be able to determine the best next step for the patient. Telephonic nurses may also need to dispatch emergency services if a patient is in a life threatening situation. With the expansion of telephonic nursing, there has been computer programs to help nurses triage the calls quickly and accurately. Clinical decision support software was designed for nurses to provide safety, proficiency, and continuity of patient calls. The SCHOLAR algorithm can help nurses expedite the triage process of a call and stay within appropriate guidelines as well. SCHOLAR stands for: Symptoms, Characteristics, History, Onset and Duration, Location, Aggravating or Associated Factors, and Relieving Factors. While the American Nurses Credentialing Center no longer has specific training for certification for telephonic nursing, there is still online training and education available through their organization. The future of healthcare is wide open with the development of technology. Patients are able to use computers, web portals, smartphones, and many other devices to access their healthcare as well as shorten hospital stays and monitor chronic health problems. They are also able to have quicker access to their health care providers and their team. Telephonic nursing has become a convenient cost effective way for patients to handle their healthcare needs.
Telehealth Nursing: More Than Just a Phone Call : Nursing2020
Patti Mataxen- Envolve People Care NAL – https://journals.lww.com/nursing/Pages/articleviewer.aspx?year=2019&issue=04000&article=00003&type=Fulltext
Telephonic nurse case management has been implemented by some insurance companies. With some insurance companies, those nurses are the gatekeepers. The telephonic nurse dictates whether you are allowed to be seen by the provider at the office or be forced to go to the emergency room or urgent care.
Rambur et al. (2019) determined that telehealth and telephonic nursing have profound implications for health care policy development and implementation, ongoing workforce development and analyses, nursing regulation, nursing education, and continuing education. The study concluded that new and renewed skills are needed to provide safe, effective, and culturally relevant telehealth and virtual care (Rambur et al., 2019).
My question for telehealth nurses, do you accept calls from patients who live out of state that you are in? Would you need a nursing license to practice in the states that patients are calling from? (I would think so.) What happens if the clinical decision support software is wrong or a mistake is made?
Standard certification, training, and more education would ensure safe and consistent delivery of patient care. Telephonic nursing provides an efficient, cost-effective, and resourceful way to speak with a nurse. It is a relatively new specialty and health care policies need to be more clear about its value and limitations.
Rambur, B.; Palumbo, M. V., & Nurkanovic, M. (2019). Prevalence of telehealth in nursing: implications for regulation and education in the era of value-based care. Policy, Politics, & Nursing Practice, 20(2), 64-73. https://www.ncbi.nlm.nih.gov/pubmed/30922207
You make an excellent point about state licensing! That’s one that I hadn’t though of, but it is definitely something to consider. I wonder if there is a loop-hole that allows you to work with patients in other states as long as you are working for a company who is located in your state of licensure. You can work for the VA anywhere as long as you are licensed as a nurse in the US, but as a government entity, they may have a completely different set of rules to abide by.
You have great questions about telephonic nursing, I can only speak for my position which is a little different as I do not actually give any medical advice. I discuss disease state and go over medication information. I do take calls from all 50 states and only have to have a license for Kansas and California currently. I feel that it is possible for clinical decision support software to not be 100% correct all the time, but you would also be using your nursing judgement.
This is such a great topic for a journal club. I really enjoy it because it applies to a large part of my current job. Being able to provide care to patients via telephone frees up clinic appointments for patients who truly need to be seen by a provider. Many patients think they need to come in for an appointment to discuss something with a provider than could have been dealt with over the phone by the nurse. Some smaller communities in America have limited health resources and providers which can exacerbate health disparities (Fathi, Modin, & Scott, 2017). Having that extra resource available to contact a nurse advice line can help patients determine whether they need to be seen in an ER or with their primary care provider, or if it is something that can be managed at home with OTC products or home remedies.
The increase in use of technology in the medical field has improved how we deliver health care. According to the article I found, the goal of telehealth is to improve value and deliver affordable care with high quality outcomes, while reversing rising healthcare costs (Fathi, Modin, & Scott, 2017).
I do think the above question regarding whether calls can be accepted from other states for nurse advice. It is not something that came to my mind, however I know health insurance companies have nurse advice lines so I suppose that it would be acceptable. Patients just have to understand and be aware that it is simply nurse advice, and that we are not doctors giving medical advice.
Source:
Fathi, J.T., Modin, H.E., Scott, J.D., (May 31, 2017) “Nurses Advancing Telehealth Services in the Era of Healthcare Reform” OJIN: The Online Journal of Issues in Nursing Vol. 22, No. 2, Manuscript 2.
Telephonic nursing is being used by insurance companies to decrease costs and increase patient satisfaction – it provides reassurance and directs the patient in what to do whether that be ER, urgent care, or PCP.
Policies, training, and RN experience play a big role in correctly directing the patient in what to do. The RN can video conference the patient or speak over the phone.
Rural hospitals have E-ICU and telepsychiatric services to give patients instant assessment and feedback to changes.
It will be interesting to see the changes to telehealth and to see over time if it is more cost effective. I have seen the jobs posted online wanting RNs to have compact licenses. I am curious how that works out. As well as, how they battle and protect patients from privacy violations and hackers.
Gruessner, V. (2015). The history of remote monitoring, telemedicine technology. Retrieved from http://mhealthintelligence.com/news/the-history-of-remote-monitoring-telemedicine-technology
I worked in ED for 11 years. I cannot count the number of times that someone called in to ask if they should be seen. It was a frustrating part of our jobs because we were not allowed to give any advice over the phone and that often angered the caller. I witnessed many nurses agonizing over the fact that they couldn’t tell the elderly woman to call 911 for her jaw pain or tell the mom of the 3 year old with a 99.4 temp to just take Tylenol instead of bring him to the ED. The liability of giving advice over the phone was the primary reason they wouldn’t let us do it, but it would have been such an asset to have a dedicated line to refer patients to for such advise.
When utilized, telephonic nursing can be a benefit to healthcare systems to appropriately triage and direct patients to the correct level of care, benefiting not only the patients, but the health system as a whole (Martinson & Gustafsson, 2018). I can imagine the difference telephonic nursing would have on the ED. Perhaps we wouldn’t have been dealing with runny noses that didn’t belong in the ED while doing CPR in the parking lot because someone shouldn’t called an ambulance. The impact could be powerful.
Resource:
Martinsson, J., & Gustafsson, S. (2018). Modeling the effects of telephone nursing on healthcare utilization. International Journal of Medical Informatics, 113, 98-105.