(This article was originally published in Healthcare Call Center Times in February 2021.)
PEORIA, IL—Telephone triage nursing is its own specialty. Not every nurse is qualified to take on this task. Some may not want to do it because it is so different from bedside nursing, but for those who have an interest in joining the telephone nursing profession, just what kind of academic and clinical background do nurse triage services look for these days?
This question was posed to a variety of healthcare call center leaders to get a sense for what they look for in the academic and clinical background of applicants.
Carole Willadsen, RN, Manager, After Hours Call Centers, OSF Healthcare Saint Francis Medical Center, Peoria, Illinois
“Currently we have the following qualifications in our job description:
• Graduate of an accredited RN program with BSN within six years from date of hire
• Minimum of five years of related acute or ambulatory clinical experience (preferred)
• Basic computer and keyboarding skills required, minimum typing speed of 35 words per minute
• Well-developed assessment, communication, and critical thinking skills
• Ability to work autonomously
Rationale:
• RN: level of preparation necessary for provision of patient care requiring patient assessment, planning, and evaluation (American Academy of Ambulatory Care Nursing definition). I have seen much discussion about LPNs for call center but there is general agreement that the RN is the level who should be completing the triage process. The BSN requirement within six years has been a Magnet requirement for the hospital for which we work.
• Industry standards for experience seem to be three to five years (per AAACN). We increased from two years to five years of experience several years ago; we were finding that the added years of experience added depth to their knowledge base. We prefer backgrounds in office telephone triage, ED, or pediatrics. These areas strengthen their knowledge base so that the new nurse learns the triage process more effectively. We have had nurses from other areas of expertise enrich our services as well, sharing information with their colleagues. We have developed modules in behavioral health, pediatrics, newborn, and OB/Gyn to help shore up any knowledge gap areas for new MP.
• Computer skills—if they spend too much time concentrating on typing, we find they are not listening to the caller’s story and may miss pertinent details OR the person takes hand-written notes and then spends MORE time in after call work to create the encounter. Thirty-five wpm is not fast but we do find that it is faster than some applicants are able to type, especially if they have been hospital nurses and used to check lists rather than typing in the SBAR (Situation, Background, Assessment, Recommendation) format.
• The assessment, communication and critical thinking skills are more likely to be present with the extended work experience requirement. We ask specific questions in the interview in these areas. We assess communication skills over the phone (first interview) and then in person for second and third interview. Critical thinking and assessment skills are assessed in the peer interview as well. We also have them job shadow, assessing what questions they ask, do they seem interested, do they seem to process the information easily—our staff rate these experiences as well.
• Autonomy: with the after-hours program, the nurse handles the call about 90 percent of the time without contacting a provider, determining best site of care with the use of the Schmitt-Thompson protocols. Ninety percent of the staff work remotely and although others are available easily through instant messaging or by phone, they need the expertise and confidence to handle most calls independently.”
Beverly Hansen, RN, Nurse Manager, After Hours Program, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
“Experience: Minimum of five years of nursing experience. Pediatric nursing experience preferred. This is because we believe that critical thinking skills are developed and honed during those initial years working as an RN, as well as assessment skills and nursing judgment. I have nurses who have come from all different inpatient pediatric backgrounds including NICU, Cardiology, and Rehabilitation. They transferred to the department motivated for a change and a desire to expand their nursing knowledge and have succeeded.
“Academic: Experience is of more value than the degree attained. I have nurses who have diplomas, associate’s degrees, and bachelor’s. There is no academic requirement except to graduate from an accredited nursing school that is recognized by the states in which we provide telephone triage service.
“I have several nurses who have advanced degrees as well. I am concerned about the nurse with a Nurse Practitioner degree doing nurse triage because it can be difficult to take the “NP hat” off and remember they are to triage, not diagnose, the patient. The NP’s I have hired did not practice general pediatrics or did not work as an NP in their previous jobs.
“We always have interested nurses shadow a nurse prior to the interview to give them a real picture of the work. Because all of our staff is working from home, they often have a picture in their mind of sitting waiting for calls when the reality is that the call volume is non-stop and the work can be stressful. This can help weed out those nurses who recognize that this is not the job they thought they wanted. I also get feedback from the nurse who hosted the applicant. If they arrived there late, or they asked good questions, seemed enthusiastic, or appeared more focused on the schedule than the telephone triage process, etc., this can have an impact on the hiring decision.”
Karen Brown, VP Business Development, AccessNurse, a TeamHealth Company, Knoxville, Tennessee
For AccessNurse, “Our minimum requirement for RN’s experience is three years. Three years of experience seems to be an industry standard—For us, a nurse must have exceptional assessment and critical thinking skills to hire with only three years. In-patient experience provides great depth in working with diverse population as well as medically complex patients We really like critical care experience in that the assessment skills (identifying a potentially high acuity situation ) are very good.
“We prefer 10 years of experience with a significant time working in a hospital in ED, Acute Care or step down unit. We find a nurse with this much experience to be very solid in their assessments and projecting confidence in talking with patients. Also many nurses with this much experience have worked in several clinical areas.
“We do hire specifically for pediatrics and OB, though we have our own training programs in those specialties. We test for clinical competence and critical thinking skills pre-hire. We love to find nurses who are certified in this specialty, but at a minimum like to see at least two years of experience in the field.”
Julie Ortiz, Owner, Triage4Pediatrics,
Plano, Texas
Ortiz requires her telephone triage nurses to have at least five years experience as a pediatric RN. She says that the five year minimum is what is needed for the nurse to build a really solid knowledgebase in pediatrics and to develop their critical thinking skills.
Dan Wallis, Senior Director, Kaiser Permanente OnCall, San Diego, California
“We look for licensed RNs with two years of recent experience (within the last four years) in a call center, acute care, or ambulatory care setting. They need strong Windows navigation skills and are required to take and pass a call center simulation skills assessment.”
He says that the most successful nurses in his call center feel comfortable with a wide variety of ages and symptoms, often demonstrated by their prior work experience in acute care with a variety of ages (i.e.: ED) or experience in neonatal or pediatrics following adult care.
“Finally, we look for nurses who are comfortable with a fast pace of change and a penchant for critical thinking,” he says.
Cindy Defnet, RN, Team Leader, TeleHealth/Patient Scheduling, Bellin Health, Green Bay, Wisconsin
“I look for RNs with three to five plus years of either ambulatory clinic, in-patient hospital unit/ED or Nursing Home experience. These RNs have great critical thinking skills which are required for triage decision making.
“In the past I did hire one RN, young with one and a half years of ED experience who did not last long in the triage position. Her critical thinking skills were not developed enough for triage decision making. She sent a large volume of patients unnecessarily to the ED and inappropriately paged providers after hours.”