Phone nurses answer medical questions, direct patients

They answer questions about everything from dog bites to baby bottles to vaccines in a room tucked away behind closed doors.

"It's a fun position," said Neal, who has worked as a registered nurse for 13 years. "We get some crazy phone calls and some serious ones."

Administrator Melisa Schager said the clinic's 18 nurses rotate positions, giving everyone a chance to work on the floor or field patient phone calls. She said nurses working the phones, who also handle doctor referrals, prescription refills and follow-up visit phone calls, allow nurses on the floor to provide patients with their full, undivided attention.

"A lot of the patients we get phone calls from are non-compliant patients who don't want to come in," she said. "We find out if they can be treated without coming in."

Since she cannot physically examine the patient or see signs of weakness or fatigue, Neal said she has to be on her game when it comes to her communication skills.

"If it's a phone call and you're triaging, you're going to ask a lot more questions," she said. "Typically you're asking the same questions on the phone as in the exam room. You may have to dig a little deeper."

Schager said the nurses follow a list of protocols set by the clinic's physicians to determine whether the patient can be treated by phone, needs to come to the office or should go to the emergency room. If the situation doesn't fit the protocols, she said the phone nurse consults with a physician.

Neal said she can tell when a consumer product recall or a new health recommendation has gained media attention. The phone lines will light up, and patients will asked her to prove or debunk the information.

"People will read things on the Internet and it's absolutely false," she said. "You have to go though the facts with them."

MY NURSE SEES STEADY CALL VOLUME

Twenty-four hours a day, seven days a week, 22 registered nurses answer medical questions from across Iowa via phone in a spacious office in the Mid American Energy Building in downtown Sioux City.

My Nurse is a health information service sponsored by Iowa Health System and its affiliates which include St. Luke's Regional Medical Center. It provides physician after-hours services for a number of clinics and providers across the state.

Licensed nurse practitioners on staff also make follow-up calls to patients who have been discharged from any of the Iowa Health System affiliates.

"We just handle a variety of general health questions, as well as assessment of systems from referral to an appropriate level of care," said Ann Schauer, manager of My Nurse. "That's our main goal. We cannot diagnose."

My Nurse also provides referrals to physicians and services available within Iowa Health System and the community such as support groups and clinics, according to Schauer.

"Sometimes we get a patient who calls and we do an assessment and we say, 'You need to see a provider within four hours.' And they don't even have a family doctor," she said. "We haven't done them a service. We need to provide them with a physician referral or maybe to an urgent care clinic so they can seek the care that they need."

Schauer said My Nurse nurses answer roughly 350 calls a day. From January through June of this year they fielded more than 61,000 calls.

"We have a lot of parents that call in with children with fevers. 'At what point do I need to take my child in to be seen?'" she said.

For adults, Schauer said questions about abdominal pain, colds and influenza are common.

"It depends on the season, right now we have sprained ankles and then obviously in the wintertime we get the influx of the influenza calls," she said.