This week’s Blog is written by Ellen Edwards (@EllenCEdwards). Ellen is a Lead Clinical Educator/Trainer for the NHS 111 Wales Programme and one of this year’s Florence Nightingale Foundation (@FNightingaleF) Digital Leadership Scholars.

The Covid19 pandemic has shed light on alternative ways of working none more so than in Telephone Nursing and Remote Clinical Decision Making (RCDM). Also known as telephone triage, telephone nursing has been a growing specialism, within the UK, since 1998 with the creation of NHS Direct in England and Wales. So after 23 years, why is this specialism underrepresented in Nursing research and education? Is it because the role is not fully understood or is it because as Telephone Triage Nurses, we lack visibility?

As student nurses, we all looked upon specific specialities as the Holy Grail, with many coveting roles in Critical Care or Emergency Nursing. These specialisms are autonomous, innovative and lifesaving, but so is telephone nursing.

There is a common misbelief within the nursing community that telephone triage nursing is a role you go to when you are no longer able to work in a face-to-face clinical environment. It is seen as ‘an easy option’ and that you ‘just follow an algorithm’ but that is not a true reflection of the role. NHS Direct and 111 have been propelled into a position as the ‘front door’ to health care, especially in the Out of Hours period. We are the first point of call for care, many patients encounter when they are at their most vulnerable and because of this we are more than just a voice at the end of a telephone.

Telephone triage utilises assessment and clinical reasoning skills, enabling the nurse to assess the patients’ needs safely and effectively, and prioritise them to the most appropriate service, if a service is needed at all. Clinical Decision Support Software has been designed to support the nurse in this assessment but we all know that patients do not fit into an easily defined box. Clinical knowledge and experience is critical in ensuring the patients receive the most appropriate care. Developing confidence to trust your intuition and that ‘gut feeling’ is imperative in a successful career as a telephone triage nurse, but how do you do this when demand is high and morale is low?

Professional networks have been recognised, throughout healthcare, to encourage community and a sense of common purpose. These networks enable feelings of belonging and in turn improve confidence and encourage continuous improvement and learning. In order to build the professional identity of telephone nursing and increase representation in nursing research and education is to first build that professional network. The question is how do you build this network, where do you start? How do you get nursing to recognise the rebirth of telephone nursing as a specialism? Representation and visibility is key! My aim through my scholarship is to promote the role and build the foundations for a telephone nursing professional network. My desire is for telephone triage nurses to represent at RCN congress, leading change and guiding improvement. Bringing the specialism to pre-registration nursing so not only to inspire the telephone triage nurses of tomorrow but to embed the principles of good practice so that they can be utilised throughout the nursing community. Telephone triage is becoming a part of the role of many advanced and specialist nurses however is this supported by training and evidence? A professional network could develop and guide this training and evidence, building best practice. My experiences so far, within my scholarship is that NHS 111 and telephone triage is often, not considered in policy change and clinical pathways but once the benefits are realised and the specialism is represented the collaborative working can begin. All it takes it us having a seat at the table.

The Florence Nightingale Foundation Digital Leadership Scholarship is a unique opportunity to fly the flag for telephone nursing and the specialism I am so proud to be part of. I am using this opportunity to encourage the conversations and challenge the misconceptions. I hope that by improving visibility we can encourage our staff to feel empowered to lead change and firmly promote and cement our worth in successful evidence based patient journeys.

Ellen Edwards

Lead Clinical Educator/Trainer

NHS 111 Wales Programme