Telephone Triage Nursing: Interview with Sara Williams, RN-C, MSN

My Specialty

Telephone Triage Nursing: Interview with Sara Williams, RN-C, MSN

Using listening skills to assess and advise patients

By Keith Carlson, RN, BSN
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Sara Williams, RN-C, MSN
Director of Patient Health Management, St. Jude Medical Center, Fullerton, Calif.

Tell us a little about your nursing career.
I began my career in Akron, Ohio, in 1984. I worked as a staff nurse in critical care and the emergency department and then trained as an operating room nurse and worked on an open heart surgery team for several years.

I moved to California in the late 1980s and continued working in critical care. In 1999, I decided I needed a change and took a position as a staff nurse for a telephone triage center. I soon learned that I loved teaching callers how to care for their symptoms and enjoyed the focus on wellness rather than disease management, which had been the focus of my career thus far. Two years later, I accepted the position of manager for the nurse advice line and continued in that role for eight years. I stepped away from telephone triage for a few years and became the program manager for the acute stroke program at St. Jude Medical Center. In addition, I developed programs to address the needs of our patients after discharge.

At that time, I became the director of patient health management and once again took on the responsibility of leading the nursing call center. Incorporating the concepts of patient education and wellness with programs to create safe transitions from the acute care setting to home has been an exciting opportunity and become my passion.

What certifications or trainings are recommended for this specialty?
I hold a certification in telephonic nursing practice from the National Certification Corporation. This certification is no longer offered, but telephone triage nurses can obtain board certification in ambulatory nursing, which is the recommended certification for this nursing practice.

Please share with us the challenges of your specialty area.
Telephone triage requires a unique skillset. The triage nurse must have excellent critical thinking skills and be able to assess for life-threatening conditions without being able to see the patient. The nurse must be able to ask open-ended questions to elicit a response from patients that will ensure that a true picture of the patient’s health is obtained.

All documentation is electronic and several programs are utilized simultaneously to ensure that the patient is cared for effectively and efficiently. The nurse must also ensure that patient calls are handled in a timely manner.

What essential skills are needed to be a telephone triage nurse?
Excellent computer and assessment skills are essential. Our telephone triage nurses have at least five years of bedside nursing experience. We adhere to the Patricia Benner theoretical framework, which identifies five stages of nursing skill, ranging from novice to expert. We want to make sure that our nurses are at the expert stage before attempting to provide telephone triage. The expert nurse is able to have an intuitive grasp of clinical situations and pick up on what’s happening on the other end of the phone.

How does telephone-based nursing address issues beyond acute symptoms?
We have utilized the expertise of our telephone triage nurses to provide follow-up phone calls for our recently discharged patients. The nurse provides medication education, performs medication reconciliation and ensures that the patient has a follow-up appointment scheduled with their physician.

Telephone triage is an important component in promoting wellness and provides a service to our patient that is extremely valuable during this time of change in our healthcare industry.

What would you say to a nurse who might be interested in this area?
Sharpen your assessment skills. Nurses who take on the position of a telephone triage nurse must be able to assess patients without being able to see them. Working at the bedside for at least five years provides an excellent foundation for this skill. This is not a specialty where new nurses without experience can excel.

Do some of your nurses still work as bedside nurses?
I currently don’t have any nurses who still work at the bedside, but we spend a significant amount of time educating our staff, providing the latest education and information so our nurses can remain current on medications, treatments and symptom management.

How do you assess the quality of your services?

All of our calls are voice recorded and we perform monthly audits of each nurse on the team. Those recorded calls can be used for coaching of the staff when appropriate.

Do you utilize Skype or video conferencing?
Our technology doesn’t allow us to do that at this point, but we’ve discussed this as a possibility in the future. However, our telehealth program uses remote video conferencing with off-site physicians for clinical assessments and consultations in our community health centers.

What are the liability issues of telephone-based nursing?

Nurses work off of symptom-based guidelines that are approved by the medical director and cannot deviate from those orders unless the on-call physician approves the change.

How much of your work is managerial in nature, as compared to clinical?
I primarily focus on managerial responsibilities as the director of the nurse advice line, but I still step in and help out with direct patient care as needed.

Do you belong to any specialty organizations?

I am presently a member of Sigma Theta Tau International and the American Stroke Association.

What are your broader career plans?
I am passionate about the continuum of care and I am aware that we need to change the way we care for our patients to ensure that we can continue to provide appropriate care with shrinking reimbursements. Shifting our focus from disease management to wellness is extremely important during this time of change in our healthcare environment.

The nurse advice line must be an integral part of this plan to address wellness as well as patient health management.

We have developed successful disease management programs to address the needs of our chronically ill patients, but we need to also include wellness and the management of patients before they develop a health crisis. My goal is to integrate the programs to develop an approach to care that promotes the overall well-being of our patients.  

Keith Carlson, RN, BSN, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at

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