The Saga of the “Phone Nurse”
While the day wears on at a busy community health center, I keep trying to stay abreast of the insurmountable number of phone calls coming in. As the clinic phone nurse, my method is to work as hard as I can to keep the voicemail box empty. From 0800 on, I check messages, write them down, and call patients back.
On good days, other voicemails come through while I’m returning calls to patients. On bad days, the moment I hang up from checking messages, my enemy (that blinking message light) never stops winking at me, daring me to try to stay one step ahead of it. I check messages and call back, and check messages again. It’s an infinite loop that takes all my focus and energy to control, leaving me no time for any kind of fulfilling hands-on nursing.
As I start to think that the only way to fix these tsunami waves of voicemails is to hire another nurse to help, I get the opportunity to share my burden with Melissa Stratman of Coleman Associates, who happens to be conducting a review at my clinic this week. With my meticulous log of voicemails I hope to show her my problem: I need more help. Certainly, she’ll see it, and recommend we hire more phone nurses.
She watches as I go through my routine: checking messages and writing them down, all the while hearing the little repetitive tune of another phone call coming in. I do my best to ignore it and focus on the voicemail I’m listening to. She asks why I don’t answer the incoming call. Puzzled, I explain that I’m checking messages now. The person that left the voicemail surely deserves to have their needs addressed before whoever’s calling right now.
Melissa patiently explains that I’m taking care of a message before I take care of a live person who is ready to talk to me right now. She suggests that if I answer the phone and address that patient’s immediate issue, it’s one less voicemail to deal with. She conveys the idea that checking the voicemail, calling the patient back, and documenting the phone encounter takes double the energy (and work) than it would to answer the phone and deal with the patient’s concern now.
I explain that I can’t possibly answer every single phone call, because that would mean hanging up in the middle of a voicemail or a phone conversation. She reminds me of what I already know: the people in front of me (in person, or in my case on the phone) take priority over messages or call-backs.
Just to amuse her, even though I know how far behind this will put me for the day, I agree to try her method and simply answer the phone. I am worried about the amount of voicemails that I’ll generate. At first I was annoyed to hang up in the middle of a voicemail, or to put a patient on hold, just to answer the other line, until I started realizing that the number of voicemails was rapidly decreasing throughout the day.
I found out that when I simply answered the phone “live,” far fewer people left voicemails; and that when I checked a message, it was usually from someone that I’ve already spoken with, because people tend to keep on leaving messages until they reach a person or give up trying. I discovered “live” phone calls didn’t take me any longer than chasing down people who had left voicemails. The work is the same, only done in a better order.
It takes less time to answer patient calls live than it does to review VM. And it’s more satisfying to patients & staff.
My 50 daily messages went down to just 10 – in a single day. Eventually my boss and I had to develop a new job description for me because I found myself with tons of time to do other things – like finally getting to be a nurse, helping people, face-to face, outside of my cubicle.
The blinking voicemail light is no longer my enemy, but a simple phone feature that barely requires my attention anymore. The best part is that I seldom find an angry patient who’s been lost in voicemail oblivion. Patients are happy to reach a nurse, to get an answer, right now, when they need it.
It’s challenging to work as the phone nurse in a busy clinic, tough to keep up with the sheer volume of voicemails. The work is constant: checking the voicemail, documenting the call, calling the patient back, solving the problem, and starting over again. It takes a long time to get through all the necessary steps to call back all patients and keep the voicemail box empty. It is a cynical game of catch-up.
It’s frustrating and thankless, as nurses burn out from the repetitive call-back loop and patients are irritated by the phone system and the time it takes the nurse to call them back.
Patient frustration leads to repeated phone calls tying up the lines, and multiple voicemails to be checked, documented and addressed.
A common solution is the reactive approach: check voicemails faster, call people back faster, document faster, and start over again. This approach lends itself to mistakes, adds to nurse burn-out, and only fuels patient aggravation.
A preventive approach is savvier: here the aim is to prevent voicemails from being created in the first place by answering the phone as the calls come in. Taking care of the patients in front of us, whether in person or on the phone, makes prioritizing a no–brainer.
Proving that the preventive strategy works is easy, too: you simply track the decreasing number of voicemails. As the patients’ needs are being addressed right away, they have no need to keep calling.
In reality, it is not ‘easier said than done’. It’s just as easy to do: simply answer the phone.
Nurse satisfaction also increases, as the number of satisfied patients increases and the amount of time on the phone is actually less than before. No more looking up phone numbers, leaving messages and playing phone tag. The best part of all, though, is the amount of time the nurse is freed up to be a nurse again, in whatever capacity desired. The possibilities, like the phone lines, turn out to be wide open.
Written by Laura Spindola, RN