The sound of a grunting newborn in the background was enough to convince Lisa Thornton, RN, BSN, FNP/ C, that the father on the other end of the telephone needed to call 911 right away.
"Newborns don't make the kind of sound I heard, but the father insisted that I listen to his concerns about his newborn's lack of appetite," said Thornton, a pediatric triage nurse for the nurse line at Children's Healthcare of Atlanta. "I could hear the baby making that sound and knew it was a serious situation, but I finally persuaded him to call 911. If he hadn't, I'm sure that baby wouldn't be alive today."
Nearly 100 nurses and customer service representatives staff the 404-250-5437 nurse call line at Children's Healthcare of Atlanta 24 hours a day, 365 days per year. They manage calls from the public, after-hours calls from physicians' offices and the pediatric nurse advice line for one of Georgia's major health insurers. Callers range from parents concerned about unusual symptoms to the babysitter with a youngster who is vomiting or may have lodged something in his or her nose.
"We have to be up to speed in many areas because we receive so many different types of calls," Thornton said.
Dr. Joseph Simon, medical director of the nurse call center, developed the protocols used by the nurses there.
"The protocols are designed to catch anything emergent that needs to be treated now, even if it's not the main reason for the call," Thornton said. "Dr. Simon has done a fabulous job of creating these protocols for every health issue."
Thornton began her nursing career in the Emergency Department at Children's in the late 1990s. She joined the call center in 2002 and telecommutes, as do about 50 percent of the nurses in the department.
She has a laptop and virtual telephone access, working from a dedicated space in her home. The facility at the hospital is designed with cubicles.
The Children's Healthcare nurse call line handles about 800 calls each weekday and between 2,600 and 3,000 calls on weekends.
"That's 325,000 calls a year," Thornton said. "We stay very busy, especially during the flu season." When the pace slows, the nurses study protocols and educational materials.
The center works on a call-back system, with customer service representatives gathering basic information and inputting it into a queue that appears on nurses' computer screens. Nurses call the patients back, sometimes immediately after the patient finishes speaking with customer service representatives.
"We can see what calls are waiting, and are constantly looking at the list to give priority to those that may be more critical," she said. "Some patients may need to see a doctor right away or call 911. We may tell others that they can wait to see their doctor the next day. Sometimes we give home-care instructions."
Call center nurses must have a variety of experience and skills.
"Clinical experience, a background in triage, the ability to multi-task and good assessment skills are all important," Thornton said. "If you're working in a pediatric setting, you must have pediatric experience, because kids are not little adults."
Work hours parallel the options offered to other nurses and the pay differential system is similar. At Children's, nurses work a wide range of shifts, some part time and some full time. The average salary for a full-time telephone triage nurse is between $45,000 and $50,000, depending on experience and shifts worked.
"Before I had this job, I had the misconception that the call center only handled new-mom questions, colds and coughs," Thornton said. "We do so much more than that. It's up to us to determine whether a child needs immediate care and to help the caller make the best decision about the situation.
"Even though we're not at the bedside, we're constantly impacting the lives of children and their families."