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| Response of a telephone triage nurse | ||
By Anonymous RN Published July 1999
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I am writing in response to the Telephone Triage Nurse
discussion on this web-site. First of all, I wish to identify myself as a Registered Nurse licensed in Pennsylvania and secondly, inform you that I have had experience working for a managed care company as a "Telephone Triage Nurse". I have approximately 6 years of clinical experience that I gained as a staff nurse in emergency departments and approximately 5 years experience in the roles of utilization review nurse, telephone trige nurse and case manager. I currently do not work in the Healthcare or Insurance industry. If you find anything about me that is of interest, might I point out the last sentence of the previous paragraph... I have left the medical field - completely. I graduated from an accredited school of nursing and from there I went to work in one of the largest hospitals in the city of Pittsburgh (now bankrupt). At that point in my career as a nurse I felt very proud. As the years went by I saw an alarming trend- a decrease in healthcare staffing and an increase of patient acuity. It became apparent to me that my liability as a nurse was increasing, so I left the hospital setting. I went to work for a national managed care company as a utilization review/telephone triage nurse. As I gained experience in these roles I noticed a trend there as well- an increase in job availabilty in managed care. My last job in the managed care arena was the role of "Case Manager". I worked for a medical insurance company in western Pennsylvania. I was there for a short time because I saw an alarming trend there as well. First of all I noticed the size of the company. It was huge. I am convinced that there were more nurses and doctors working for this insurer than any hospital in western Pa. Secondly, the emphasis placed on my role was not on assisting patients but rather on saving $money$ for the corporation. My conclusions: 1.Of all the telephone triage algorythms I have seen, none of them were approved for use by nurses. ALL of them were approved by MEDICAL DOCTORS... 2. When I worked as a telephone triage nurse here in the state of Pa. both myself and my co-workers questioned our employer about the invisible lines of practicing nursing Vs. practicing medicine and also the ability of us to offer the telephone triage service out of state.(We did telephone triage for people nationwide while sitting in Pittsburgh.) Never did we get an answer on paper in regard to the liabilities of these issues. I have yet to meet a lawyer or physician who has the guts to put this on paper. 3.This observation will not be popular with any physician I know... Isn't one of the the roles of a PCP that of gatekeeper? If so, why are the PCP's patients directed to call a nurse in some far away place? PCP's recieve reimbursement based on capitation - shouldn't the PCP be the person that recieves the phone calls at 3:00 AM and then determines what treatment the patient should recieve? Isn't that what a "Gatekeeper" is? I am inclined to defend my fellow nurses and say that "Nurses are not practicing medicine by doing telephone triage. Instead they are practicing "gatekeeping", a role that physicians are to lazy to do..." (Sorry doctors but aren't you guys the ones who contract for capitated rates and for bonus checks at the end of the month for lower utilization of healthcare resources?) 4. My last observation: When I worked for that insurance company I noticed the large numbers of nurses, doctors and other professional staff... I often thought about money there (thats what I was paid to do.) And then I looked at the size of the company again. And then I thought about the cost of the salaries and the cost of the rent that the insurer paid and the cost of the benefits it paid to its employees and the cost of the .....(on and on etc) And then I thought- I bet if we added up all that money that everyone in the state of Pennsylvania could have a medical indemnity plan. And then we wouldn't have telephone triage nurses.... |
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