How can LPNs be utilized in telephone triage?
I’m frequently asked about the advisability of utilizing LPN/LVNs in the process of telephone triage. The short answer is “don’t do it.” Don’t even put them in the position of asking questions (taking a history) prompted by decision support tools or other types of checklists, because this, too, requires interpretation.
The problem with LPNs functioning in this fashion is that from the minute they pick up the phone until they hang up (and beyond), interpretation is taking place (aka, critical thinking and clinical reasoning). The history taking is perhaps the most complex part of the call, and certainly the key to a successful telephone triage encounter. Just think of how many times (verbally or mentally) you say, what do you mean by that? Clarification and interpretation are key elements of the history taking, which is actually the assessment phase of the call, the first step of the nursing process, which LPNs and LVNs are not licensed to do independently. How much more independently can a nurse function than in a phone call with a patient?!? Even if s/he presents the data collected to the provider or RN, the assessment has still occurred (and conclusions drawn about what’s important) in the initial interview.
The ability to exercise clinical judgment and use clinical reasoning via a critical thinking process is the linchpin to the provision of safe and effective patient care in telephone triage.