Improving the Quality of Telephone Triage Care by Obtaining Board Certification Exam

Background: The US Bureau of Labor Statistics found that there is an increasing demand of nurses in a wide range of settings, especially, those nurses who are specialized with the highest levels of experience and skills. There is strong evidence that nurses who are certified in their area of expertise provide safe, effective, patient-centered, timely, efficient, and equitable care. Healthcare delivery is shifting from inpatient to ambulatory care settings. Thus, nurses in telephone triage must prepare to meet with this challenge. It is beneficial to provide nurses with tools to help them prepare to become certified. Providing nurses review materials for the nationally recognized certification exam will help them to prepare well to achieve this goal. Certification allows the nursing profession to demonstrate its expertise in the specialty. Nurses with specialty certification are respected among their peers and other healthcare professionals. Most importantly, as the complexity of patients increases, it is imperative that nurses have the knowledge, competence, and skill to care for these patients.

Purpose: The purpose of the quality improvement (QI) project was to increase certified nurses in telephone triage.

Method: A QI project was conducted using the awareness, desire, knowledge, ability, and reinforcement (ADKAR) change management model to guide, prepare, and engage nurses to increase the certification rate in the unit successfully.

Results: 7 nurses have been certified in 2019 after the implementation.

Baseline data prior to implementation:
25 (100%): nurses expressed the desire
15 (60%): nurses certified in other specialties
3 (12%): nurses certification expired
7 (28%): nurses not certified and interested in certification
19 (76%): nurses were interested in having a second certification

Barriers: Cost, time, and family obligations

The implication for nursing practice: The network telephone care program is a service line for triaging veterans with complex conditions. Nurses have the knowledge and skill to manage the symptom calls, but not all are certified. These nurses do a tremendous job in assessing and providing proper disposition daily, and they deserve to be recognized for their efforts. Therefore, taking the certification exam will increase nurse satisfaction, increase patient safety, and will promote staff retention. Lastly, having funding for the certification review will be an incentive to enhance a strong desire for this professional advancement.

Conclusion: The results of the survey indicated that 25 nurses showed the desire in taking the certification exam and understood that change was needed to provide a high quality of care and demonstrate competence, knowledge, skills, and professional satisfaction.