Examining Knowledge, Confidence and Stress in Telephone Triage Nurses

Purpose: The purpose of this comparative descriptive study was to describe the current preparation, perceived knowledge, confidence, and stress of TT RNs. Investigators looked for relationships between those values.

Background: Telephone triage (TT) is a nursing skill which requires complicated critical thinking and independent judgment, with risk of serious outcomes if mistakes are made. It requires a skill set that is not included in standard nursing curriculum, nor learned through face-to-face care. Stressed nurses display more frequent cognitive lapses. Experts recommend in-depth didactic education and live call coaching to prepare RNs for TT practice; however, actual preparation of practicing TT RNs was unknown.

Methods: An online survey was emailed to all ambulatory care RNs in a large Northwestern health system. Nurses were asked to respond to questions regarding TT education completed, perceived knowledge, confidence, and stress. Two open-ended questions were included that asked them to elaborate on sources of stress and give recommendations for support. They were asked whether they were interested in completing more TT education.

Results: 47 RNs participated, resulting in a response rate of 11%. The majority of RNs reported having a bachelor’s degree and worked full time in specialty care, call center, primary care, or home care. The amount of TT education completed was highly variable, from none (n = 7) to over 30 hours. Most RNs had completed casual TT training (n = 38), about half had completed formal TT training (n = 24), and about a quarter (n = 12) had completed TT simulation. Deficits in knowledge and/or confidence were noted in several topics when applied to TT practice including scope and standards of telehealth, use of evidence-based practice, use of the nursing process, legal risks, best practice for challenging calls, documentation standards, identifying goals and plan of care, caller education, and appropriate delegation. RNs reported the most stress from dealing with serious patient issues which could result in bad outcomes if mistakes are made and from having periods of work with many hours of activity. Younger nurses and nurses who reported being overworked were more likely to report stress from other sources. Nurses who received formal or simulation education reported higher perceived knowledge. Participants recommended more TT education and decision-making support, more access to providers to ensure timely care, and work redesign to prevent interruptions related to multi-tasking. 94% of respondents indicated they would be interested in completing more education specific to TT.

Conclusions: Variability in TT RN preparation, deficits in knowledge and confidence in TT, and participant recommendations support the Core Curriculum for Ambulatory Care Nursing (2019) recommendation of a formal and standard orientation to telehealth. Workflow redesign to eliminate multi-tasking and increase provider availability may decrease TT RN stress and increase patient safety.

Learning outcomes: Attendees will be able to describe the preparation, perceived knowledge, confidence, and stress of practicing TT RNs in various ambulatory care settings in a large health system. They will be able to describe recommendations of those RNs to improve support for their practice.