Telenursing: Competency Behind the Call

In late 2010, one organization recognized the need to serve their growing patient population beyond clinic hours. As a result, the call center (CC) began in 2011 with three full-time (FT) RNs, including a manager to provide much-needed round-the-clock support to cancer patients and caregivers. Several factors drove changes that, now nine years later, allowed the CC to solidify its role as an integral player in the delivery of care at the organization.

When determining education and competency needs, the call center had been operating under the umbrella of the outpatient nursing department, and as such, annual competencies, ongoing education, and the RN orientation program are dictated by the same requirements as RNs working in the clinic, oncology treatment teams, same-day surgical unit, and the specialty teams. However, telephone triage is a very specialized and challenging form of nursing. Education and competency requirements are very different than other nursing practices.

A team of nurses working in the CC developed an ongoing education plan for existing CC RNs, an onboarding process for new stakeholders, and an annual competency plan that incorporated JCAHO requirements.

Method: The project team analyzed CC metrics, key performance goals, staffing patterns, recruitment activities, and onboarding process and surveyed CC RNs. Based on these findings, the project team identified specific practice areas where improvement was needed, including the development of an effective onboarding process for RNs new to not only the call center, but telehealth nursing.

Findings
• Comprehensive orientation and onboarding process needed for new CC RNs
• Annual nursing competency program for CC RNs that also included JCAHO requirements
• Need for specialized telemedicine/telenursing ongoing education for CC RNs that is grounded in evidence-based practice
• Explore staff development opportunities for CC RNs

Implementation
• Journal club specific to telenursing and telehealth operations
• Development of comprehensive orientation program during onboarding process, designed by CC stakeholders based on educational need and past experience
• Development of annual competency program specific to telenursing and telehealth needs and operations
• Development of specialized courses addressing topics that pertain to telenursing and telehealth that are available to all CC RNs through Healthstream, our education provider.
• Excellent clinical resources and education opportunities made available to all stakeholders including free continuing education, tuition reimbursement, and reimbursement for pursuit of specialty certification

Results
• Improved job satisfaction for current CC RNs
• Increased retention of new CC RNs
• Improvement in patient safety and satisfaction ratings

References
1. Mangold, K., Tyler, B., Velez, L., & Clark, C. (2018). Peer-Review Competency Assessment Engages Staff and Influences Patient Outcomes. The Journal of Continuing Education in Nursing, 49(3), 119-126. doi:10.3928/00220124-20180219-06
2. Mataxen, P. A., & Webb, L. D. (2019). Telehealth nursing. Nursing, 49(4), 11-13. doi:10.1097/01.nurse.0000553272.16933.4b
3. Rutenberg, C., Greenberg, M. E., & American Academy of Ambulatory Care Nursing. (2012). The Art and Science of Telephone Triage: How to Practice Nursing Over the Phone.
4. Standards. (2019). Retrieved from https://www.jointcommission.or...
5. Van Houwelingen, C. T., Moerman, A. H., Ettema, R. G., Kort, H. S., & Ten Cate, O. (2016). Competencies required for nursing telehealth activities: A Delphi-study. Nurse Education Today, 39, 50-62. doi:10.1016/j.nedt.2015.12.025