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  • 1.  Screening vs Triage

    Posted 07-14-2022 09:38
    Hello,

    I am an ambulatory educator for an organization with 56 clinics that consists of a mix of primary care and specialty. We have recently acquired a couple clinics that were previously private practice. The staff in this clinic consist of a mix of RN's and LPN's. The LPN's are struggling with the fact that we told them they cannot 'triage' and they feel offended by this. We have showed them the organizations scope of practice and have given them the difference between triage and screening but this is not satisfying them. Does anyone have an algorithm, articles or anything to assist us with education on this topic? 

    Thank you in advance!

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    Jody Will BSN RN
    Sarah Bush Lincoln
    Mattoon IL
    (217)238-4772
    jwill@sblhs.org
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  • 2.  RE: Screening vs Triage

    Posted 07-14-2022 11:27
    Good afternoon Jody,
     You can start with your state's Board of Nursing. That will be helpful in distinguishing the scope of practice. Also the AAACN's Scope and Standards of Practice for Professional Telehealth Nursing, the 6th ed.. I am also reading Perspectives in Ambulatory Care Nursing by Caroline Varner, Deena Gilland and Beth Ann Swan.

    Hope these are helpful.

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    Tomika Green MSN,RN,AMB-BC
    Nurse Clinician
    VCU Medical Center
    Henrico VA
    (804)647-0199
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  • 3.  RE: Screening vs Triage

    Posted 07-15-2022 00:54

    LVNs are able to screen, gather data and are responsible to know normal vs abnormal. An  LVN can gather assessment data the same as an RN. The difference in their scope of practice is in being able to make a decision based on the data which is the  "triage" part of the process. 
    RNs can make a triage decisions whereas an LVN would need to present the data to an RN or provider to make the triage decision. 

    I learned that from an LVN and that's how I explain it to my staff. 

    I completely understand how high functioning LVNs would be insulted but it's just a small part of the triage process that is out of their scope.



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    Shiela Kerr MSN RN
    Nurse Manager
    VA San Diego Healthcare
    San Diego CA
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  • 4.  RE: Screening vs Triage

    Posted 07-18-2022 18:24
    I would show them the State regulations from the Board of Nursing. 


    Maria Jauregui-Garcia, BSN, RN

    Director of Nursing

    Community Health Centers of the Central Coast (CHC)

    P: 1805-346-3948

    F: 1805-346-3965

    E: mjgarcia@chccc.org

    www.communityhealthcenters.org

     

    2050 S. Blosser Road

    Santa Maria, CA 93458


    Healthcare for life since 1978






  • 5.  RE: Screening vs Triage

    Posted 07-19-2022 15:17
    Indiana has very similar scopes of practice for LPNs and RNs so I would be sure to check your states nurse practice act.

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    Ryan Taylor MSN, RN, CPN, NE-BC
    Director of Medical Practice Management
    Memorial Hospital and Health Care Center
    Jasper, Indiana
    812-996-8489
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  • 6.  RE: Screening vs Triage

    Posted 07-19-2022 21:35
    We feel your struggles, Jody, at our clinic.  We are integrating as well from private practice with a larger enterprise.   We have for the 1st time brought in RN toour  Ambulatory clinics to triage, and it did not go well with our MAs who have been performing their version of "triage" for literally decades.  Yes, they are offended when told they are suddenly not "qualified' to do what they feel they have been doing all along.   T True - your state statutes and nursing board are your irrefutable references as to why prior practice or LPN "triage" no longer (and perhaps never  did) apply.  

    At a quick glance of IL statutes, it does state LPNs can "conduct a focused nursing assessment".  However, what your LPNs may not yet acknowledge is that it also states that their role and assessment contributes to "collaboration in the development and modification of the RNs or APRN's comprehensive nursing plan."     Making a triage decision, even in under an organizations guided/formal triage tool,  is still developing and executing the plan, which is the scope of the RN under these statutes.    I copied the statutes below, for quick reference, from https://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1312&ChapterID=24.  

    In addition, here is a link to what the Joint Commission has to say about LPN roles in the hosptial care setting.  Although not directed to ambulatory care, it does demonstrate that even in a more acute care setting when rapid assessments are vital to prevent clinical deterioration, LPNs assessments are for data collection that must be presented to the RN for evlauation and development of nursing plan (plan being a triage decision in the ambulatory setting).  https://www.jointcommission.org/standards/standard-faqs/critical-access-hospital/provision-of-care-treatment-and-services-pc/000001666/

    Not sure if this is the input for which you were looking, but being born and raised from Peoria, IL, I felt I had to at least attempt to contribute as we are both dealing with the same growing pains.  

     (1) Conducting a focused nursing assessment and
        
    contributing to the ongoing comprehensive nursing assessment of the patient performed by the registered professional nurse.
            (2) Collaborating in the development and
        
    modification of the registered professional nurse's or advanced practice registered nurse's comprehensive nursing plan of care for all types of patients.
    .

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    Tiffany Pryor
    Registered Nurse - Family Care Triage
    Cleveland Clinic Martin Health
    Stuart, FL
    386-316-4185
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  • 7.  RE: Screening vs Triage

    Posted 07-20-2022 08:18
    Hi Jody,
    I am half-way through Carol Rutenberg's Telephone Triage video series (https://www.telephone-triage.com) and she makes a very convincing case for well-trained RN staff performing telephone triage (TT). Its defined as an interactive process between the nurse and client...that involves identifying the nature and urgency of client healthcare needs and determining the appropriate disposition. She says, there is no other form of nursing in any setting that requires more critical thinking and independent clinical judgement.
    RNs have an independent scope of practice and use the nursing process. TT requires critical thinking, excellent assessment and communication skills and a broad knowledge base. In brief, the RN uses clinical reasoning to assess, assimilate, retrieve and discard information that affects patient care. She endorses all symptom-based calls be handled by an RN; they can base decision making on the context of the call (nonverbal cues, patient characteristics/comorbidities, time of day, resources, patient preferences, etc). She provides many real-life examples of cases where these attributes could have made a positive difference in patient outcome.
    Lori Barker, MS, RN
    SHMG Allergy & Clinical Immunology
    Saratoga Springs, NY

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    Lori Barker RN
    Saratoga Hosp Med Group
    Clifton Park NY
    (518)886-5814
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