Susan Randles Moscato

Predictors of Patient Satisfaction With Telephone Nursing Services

Patient satisfaction has been shown to be a factor in clinical outcomes, health care quality, and patient follow-through. Thus, a high level of satisfaction is a desired outcome of patient care. This article examines predictors of patient satisfaction with telephone nursing services among a sample of 1,939 respondents, using a conceptual model derived from the literature and preliminary work. The study was conducted in medical offices and call centers of a large national health maintenance organization. Calls were taped and content coded and then matched with caller questionnaire data. In the final multivariate predictive models, patient health status; caller ratings of expectations met by the nurse for listening, clarity, and collaboration; and nurse competence were the strongest predictors of satisfaction. Consistent with the literature, findings suggest that nurses should expand interpersonal communication skills, and systems should reduce barriers to effective listening, clarity, and collaboration with callers.

Tool Development for Measuring Caller Satisfaction and Outcome with Telephone Advice Nursing

Caller descriptions and evaluations of their experiences with telephone advice services provide unique information that correlates highly with objective measures of quality and can help interpret data from other sources. An author-developed questionnaire assessed caller outcomes of telephone nursing advice. In Phase I an iterative, purposive sample of 40 callers was interviewed by phone. An emergent design was used to develop questions, analyze constructs of interest, and test questions for a draft caller questionnaire, which was tested in Phase II. Responses to the questionnaire provided information about caller characteristics, advice call characteristics, and nurse practice behaviors that caused the authors to further revise the questionnaire. The resulting tool provides feedback to advice nurses about the outcomes of their practice and information to design orientation and development programs and support fund allocation decisions.

A model for examining predictors of outcomes of telephone nursing advice

Although telephone advice nursing is the fastest-growing nursing specialty, useful information to guide managers’ decisions about how best to structure and support advice services to achieve desired outcomes is unavailable. We identified issues and variables relevant to outcomes of telephone advice from the perspectives of callers, nurses, and the system. Subsequently, we derived a model for studying factors affecting nursing advice outcomes that will help managers identify modifiable factors to improve outcomes of care.

Making it work: organization and processes of telephone nursing advice services.

Efforts of health plans to balance service quality with cost control have spurred rapid growth in telephone nursing advice services. Service system design can affect costs, patient outcomes, and staff retention. Research has not addressed how the organization of nursing services affects practice outcomes in telephone advice settings. We describe observed variations in telephone advice nursing services and the organizational and process factors the nurses identified as supporting or hindering their work.

Telephone advice nursing services in a US health maintenance organization

We studied telephone advice nursing (TAN) in the US. We recorded 4269 TAN calls in four regions served by Kaiser Permanente, a health maintenance organization. A call description form was used to record information regarding both calls and callers. The mean call length was 5.9 min (SD 3.6, range 0.3-35.8); 300 calls lasted less than 2 min. The mean call length differed significantly across regions, from 4.4 min in Hawaii to 8.7 min in Southern California. Calls to call centres lasted an average of 6.5 min (SD 3.8), compared with 4.2 min (SD 2.9) for those to medical offices. These differences were significant. Although 42% of calls required some further medical management, only 18% (n = 754) resulted in an urgent disposition, and only 16% (n = 121; 3% of all calls) of the urgent dispositions involved referral to emergency services. The likelihood of urgent disposition varied significantly by region. Callers generally used the TAN services for the right reasons, that is, with questions or concerns that could be reasonably handled by telephone advice nurses.

New BSN nurses' perspectives on the transition to practice in changing economic times.

Helping nursing graduates transition to practice is a concern for nursing educators and employers. This article reports graduates’ perceptions of transition both when jobs were plentiful and when jobs were scarce. Survey results from comparison of 2008 and 2010 graduates demonstrated few differences. Key indicators of successful transition were positive feedback at the work site, increased self-confidence on the part of the new graduate, and acceptance by the care team. Presence of good role models, ability to ask questions safely, and ongoing feedback on performance assisted successful transition.

A Primer on the Politics of Partnership between Education and Regulation

Too often there is a separation between education and regulation, as functions appear different, yet are truly complementary. Described is an exemplar of a successful education-regulation partnership that advanced the development of an innovation, the dedicated education unit. The work of building relationships, communication, mutual need and goal setting, and trust building are described in the context of innovation within a regulatory environment that can lead to empowerment and change.

Voices from the Coalface: The Impact of Dedicated Education Units in Nursing

This chapter, in keeping with the Dedicated Education Unit principles of valuing everyone’s input, respecting and sharing their knowledge and experience, and learning from one another, presents 14 stories from people performing different roles in establishing, learning, teaching and working within differently structured Dedicated Education Units in different clinical contexts. It broadens the scope of this book by including experiences from Manukau Institute of Technology/Counties Manukau District Health Board Dedicated Education Units in Auckland, New Zealand. The stories complement the descriptions of Dedicated Education Units, from conception to sustainable management, in Chaps. 2, 3, 4, 5, 6, 7, 8, 9 and 11 (this volume) by adding a human element that gives insight into how different individuals experience the concepts and meanings of Dedicated Education Units in practice.

An American Experience: Transition to the Dedicated Education Unit Clinical Education Model

This chapter describes the transformation of the traditional clinical teaching model at the University of Portland, Oregon, into an American version of the Dedicated Education Unit. The authors place a major focus on the relationships established with the University’s clinical partners and the Oregon State Board of Nursing, the process of creating a new educational experience, and the lessons learned along the way. They explain how the urgent need to increase the number of graduates despite a dearth of faculty led to development of the Portland concept of the Dedicated Education Unit and detail key elements for successful implementation, including processes for developing strong partnerships, major roles and responsibilities, an implementation timeframe, and acknowledging the challenges to successful implementation. The chapter concludes with a discussion of the evaluation, outcomes, and future possibilities of Portland Dedicated Education Units. Here, the authors make particular mention of the significant increase in the number of nursing students and graduates per year with no additional clinical faculty for the medical-surgical clinical experiences and the role of Dedicated Education Units in Magnet hospital accreditation.