Telephone nursing: an emerging practice area.

Governments across Canada and internationally are implementing nurse telephone advice services to their populations as a means to address healthcare access issues. This paper briefly reviews the international and Canadian history of telephone nursing services and outlines the research that has established the relative safety of these services to patients. The standards, competencies and decision systems that support safe tele-practice are reviewed. The paper focuses on the realities of this emerging nursing practice. A number of concerns related to the marriage of clinical practice and call centres are identified that require further dialogue, research and debate within the profession. The call centre environment can lead to a focus on efficiency measures, such as call length and quick turnaround to the next call, without evidence to ensure that these are safe or desirable standards. Quality of work life for staff in call centres is also raised as an issue that requires more research and dialogue. Other issues include cross-jurisdictional licensure, patient safety, privatization and the differing models of telephone nursing services that are being implemented in Canada.