Kansas City Star profiles long-serving "Ask-A-Nurse" telephone resource center
April 20, 2005 -- Today the Kansas City Star ran a generally good piece by Edie Hall about the Shawnee Mission Medical Center's Ask-A-Nurse Resource Center, which has been dispensing important health information for nearly two decades and will soon log its two millionth call. Despite a troubling passage that suggests the nurses just follow a computer program and don't handle "serious" problems, most of the piece is a good look at the life-saving work of the nurses who staff the resource center.
The piece explains that since 1986, the resource center has put callers in touch with experienced nurses who help them with "common ailments and possible emergency situations alike." The Ask-A-Nurse Resource Center's 36 on-staff nurses have, on average, an amazing 28 years of experience in nursing. Besides indicating that the nurses are well-qualified, this also suggests that such services may be an important way for nurses who may no longer wish to practice at the bedside to continue to give the public the benefit of their vital expertise and experience. (A recent U.K. article about a similar nurse telephone service in that nation touched on this issue). The piece also notes that the Center operates 24/7 and that it now answers more than 127,000 calls annually, a number that has risen each year of its operation.
The piece notes that the Ask-A-Nurse Resource Center provides important "relief" to ED nurses and family physicians, who do not "necessarily" have time to provide such health information over the phone. Of course, some physicians and nurse practitioners do interact with patients by phone or online. But centers like this--which are really engaged in work that is comparable to the triage functions at which nurses excel--would seem to fill a vital health care gap. Jennifer Smith, manager of Ask-A-Nurse, reportedly says that a "huge benefit" of the program is that it dispels inaccurate and potentially dangerous information that callers may have found elsewhere. Carolyn Sellow, an Ask-A-Nurse veteran, notes that the center can help people regardless of their insurance situation, which is a potentially critical safety function in the managed care era.
The piece slips in giving a brief description of how calls typically proceed. It says that nurses "don't make diagnoses," but that they "use a computer program that prompts a series of questions to rule out serious medical problems." If a "serious" problem is ruled out, the nurses take steps to help the caller handle the situation; if a serious problem is not ruled out, they advise the caller on "seeking professional care." Unfortunately, this makes it sound like the nurses are just following a computer script, and that they can help callers only with non-serious problems; otherwise, they refer the callers to real professionals. In fact, while computers are certainly helpful tools, nurses with this much experience have a vast body of medical knowledge on top of their nursing knowledge, and we're quite sure they are often called upon to supplement and and even overrule what they see on a computer screen, as was discussed in the U.K. article. What the telephone nurses are providing is "professional care," albeit in a non-traditional setting that limits their ability to assess and intervene.
To say that the nurses do not "make diagnoses" may be correct in the sense that they are not actually seeing the patient, but not because nurses are somehow incapable of diagnosis. For all practical purposes, nurses medically diagnose and treat patients all the time, as journalist Suzanne Gordon has observed, though few nurses or physicians will admit it because of long-standing turf battles. In addition, nurses perform nursing diagnoses as a vital step in the "nursing process" that they use to formulate the science-based nursing care they need to deliver to patients. Nurses cannot deliver care, educate or advocate for patients, or refer patients to health facilities or advanced practice providers until they have made a nursing diagnosis.
Moreover, it is a mistake to call all problems that may require a referral "serious" and all others "not serious." Nurses like these can offer advice about managing health conditions at all levels of severity, especially in an era of incomplete access to care and premature hospital discharges, advice that may very well mean the difference between life and death. Indeed, the very act of deciding what is serious and what is not is a highly complex and life-saving nursing function. The piece itself appears to recognize this in reporting that the nurses have been told more than once that their advice was "life saving."
On the whole, we commend Ms. Hall and the Star for this piece about the important work of the Ask-A-Nurse Resource Center.