As a telephone triage nurse, you are effectively blindfolded while being expected to make decisions about patients. Some may not be able to speak freely because they are at work, while others may have hearing or speech difficulties.
At other times, phone reception is so bad you wish you had a pair of tins joined by string to complete a consultation safely.
Err slavishly on the side of caution and you become a receptionist, not a nurse. Stick rigidly to established algorithms and you could spend a quarter of an hour consulting with a patient who has a pimple on his chin while potential heart attack or stroke cases might still be queued up on the line. Skim over a triage encounter, lose concentration, get interrupted, forget to ask vital questions, and your patient could die. View self-limiting conditions as a cause for clinical concern and you create a climate of unnecessary worry.
From a patient’s perspective, telephone triage has to be the best thing since sliced wholemeal bread topped with seeds. Their needs are addressed. They are offered choice. The Department of Health can break open the champagne, leaving the nurse to toast herself on cold coffee dregs.
I have undertaken telephone triage for many years. I do wonder whether people truly understand just how difficult it can be and what it takes out of you. Often you are subjected to a tide of human misery, pain, anxiety and, occasionally, jaw-dropping rudeness. There is rarely time to clear your mind of the call you have just taken before wading in to the next one.
There are times when you have to coax patients to relate their stories. You are ruling possibilities in and ruling them out, keeping an open mind on possible diagnoses and the time frame in which patients may need to be advised, treated or referred.
To further complicate matters, some patients may have atypical symptoms or underplay their severity. It’s testament to the skill of triage nursing that we get things right as often as we do. Good job it’s well-rewarded. Isn’t it?
Jane Warner is a practice nurse in Devon
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