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Top-10 Traits of ‘High-TQ’ Hospice Triage Nurses

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Filed Under: LIFE OF A TRIAGE NURSE Tagged With: Art of Nursing, home health, Home-Health, hospice, nurses, supporting nurses, Triage Nurse, Triage RN

IQ… EQ… and TQ?

February 22, 2022

Top-10 Traits of ‘High-TQ’ Hospice Triage Nurses | CareXM
Tests to measure Intelligence Quotient (IQ) date back to the dawn of the 20th Century. Emotional Quotient (EQ) assessments arrived about 75 years later. The author, a former Hospice Triage nurse, posits the idea of best attributes for Hospice Triage Nurses. An assessment may someday be in the making.

Intelligence empowers us to learn new concepts and apply that knowledge to solve problems.

Emotional intelligence is the ability to learn about yourself and apply that wisdom to the world around you.

“IQ” – Intelligence Quotient (first test 1904) – and “EQ” – Emotional Intelligence Quotient (first assessment 1990) are ways to assess these intelligences.

What kind of intelligence, then – in addition to having heaps of IQ and EQ – do best-of-breed Hospice Triage Nurses have?

Best-of-breed Hospice Triage Nurses have a “High TQ” (2022) or “Triage Quotient.”

A triage nurse, especially a virtual triage nurse, expertly assesses patient and caregiver situations, prioritizes treatments, and initiates/coordinates medical care.

Having been a Hospice Triage Nurse and a Clinical Director for a hospice, here are my top-10 characteristics of a “High-TQ Hospice Triage Nurse.”

1. IN THE MOMENT, UP-TO-THE-MINUTE

Triage is an in-the-moment, up-to-the-minute skill and discipline. Best-of-breed Hospice Triage Nurses must actively, consistently, expertly (ACE) listen for, observe, and even anticipate. Telenursing Triage Nurses swiftly apply this information to elevate the patient experience, the caregiver experience, and their clinical team experience.

2. COMPASSIONATE, CONFIDENT DIRECTNESS

Being “nice” is often not nice, especially in the world of hospice and hospice nursing. Compassionate, confident, compact directness is required in communicating with patients and family members. “Death” is one of many words to not shy away from. “Hospice” does indeed mean your loved one is in the process of dying. Our comfort as an after-hours nurse on call breeds others’ comfort with what will come.

‘Best-of-breed Hospice Triage Nurses
must actively, consistently, expertly (ACE)
listen for, observe, and anticipate.’

3. HOLISTIC – MEETING THEM ON THEIR JOURNEY

Hospice is the journey to the end. We meet the patient on their journey, ever-learning and becoming increasingly aware of their wants/needs, cultural/religious implications, and any other essential insights. Such awareness and commitment ensure we meet them where they are and support them and their loved ones through to the end. We do not always know what is going on, and sometimes the patient’s emotional place can be very out of line with their physical decline. For example, even when it is clear they are dying, patients commonly think they can get better, (Kübler-Ross’s “Denial.”) Sometimes a nurse needs to not ‘correct” or educate but support the patient and let them go through the emotions or the “stages” to accept where they are. Denial is more evidenced by family members. It is common for near-end-of-life patients to be force fed by well-intentioned family. Force-feeding puts patients at risk of choking or aspirating. Sometimes you must work with the family to educate them and then let them make the choices they feel are best, even when it is not the choice you would make.

Top-10 Traits of ‘High-TQ’ Hospice Triage Nurses | CareXM
Far from ”cold,” High-TQ Triage Nurses are level. The best approach the calling with level heads and full hearts.

4. LEVEL-HEADED, FULL-HEARTED

Far from “cold,” we are level. Clarity-afforded science and insight guide us, as do full hearts and emotion at the closing of one’s life verse and other compassion points during the continuum of care. A “High-TQ” Hospice Triage Nurse answers the call of the science and art of nursing, within the pulse of life’s dance and graceful bow.

5. EDUCATION EVANGELIST, OPTIONS ADVOCATE

Best-of-breed Triage Nurses are voracious learners – about everything from Palliative Care to patients’ cultural and social nuances. We embrace our role as educators. This means being educators of patients, of caregivers, and sometimes, of our colleagues. But mostly, as educators of ourselves. We sign up for extra learning opportunities. We thirstily drink in each moment of work and life experience, using that as a reservoir to inform future decisions and actions. We recognize that sometimes we have thoughts and prejudices and accept these as places to further question ourselves and, in so doing, improve our care. We recognize options in terms of curative and comfort treatments and carefully, respectfully, dutifully communicate these options to patients and caregivers.

‘A ‘High-TQ’ Hospice Nurse
answers the call
of the science and art of nursing,
within the pulse
of life’s dance and graceful bow’

6. EGO? THE “I” IN TRIAGE IS LOWER-CASE

Hospice is the intersection of life and death. It is emotionally charged for all involved. It is not our journey, but it is our calling to aid the journeys of others. Sometimes we will take abuse – especially if we are physically remote (e.g. telephone triage nurse assisting over the phone). We understand this is an aspect of hospice and indeed humanity. Resilient, we move onward and upward.

Top-10 Traits of ‘High-TQ’ Hospice Triage Nurses | CareXM
A ”High TQ” Triage Nurse believes in others’ contributions to care.

7. HUMANIST – BELIEVER IN PEOPLE’S GROWTH, CAPABILITIES, CAPACITY

As nurses, we believe in people. As Triage Nurses and as Hospice Triage Nurses, we must optimistically believe in people’s abilities to learn, grow, and change. Once-timid, tentative caregivers can improve and rise to challenges – with our support, respect, and belief. Long-held assumptions about life and death can change, amid the realities end-of-life bring. We need to remain convinced of human capabilities and our mutual goal to elevate patient care. An “aha moment” in nursing came to me when highly religious children of a cancer patient set aside their religious distaste for Dronabinol (man-made cannabis or marijuana used to relieve extreme nausea), to allow their mother significantly increased peace on her death journey.

‘Ego?
The ‘i’ in ‘Triage’
is lower-case.’

8. COACHABLE/COACH

These lines from a vintage Police song remain with me: “When you find your servant is your master.” As a Hospice Triage Nurse, many roles interchange as we are informed by patients, caregivers, and colleagues, and, in turn, so inform them. The key here is elegantly gliding from being coach to being coachable. Both yin-yang traits are essential. As nurses we need to be humble enough to set aside what we may consider “superior” education and experience and be willing to learn from caregivers who have had more time with this patient in front of us. Science and education should not trump caregiver/family intuition but co-exist. A family member may tell you something that is not “textbook” but provides spot-on insights about what their loved one thinks, feels, or needs. In this instance a nurse who goes in arrogantly dictating what needs to happen is, of course, very ineffective. A nurse who can go in and work with the family to guide them and help them navigate the care in a situation like pain medication is far more effective. For example, consider the situation of a hospice patient’s enduring a lot of pain and refusing pain medications. Then the family shares the patient’s fear that meds will render him unable to further communicate with his family. This helps the nurse to know how to address the real issue of confronting the ensuing reality of death with support of family together, rather than commanding the pushing of pain meds.

9. COMFORTABLE – IN SILENCE, IN NOT KNOWING SOMETHING

Ancient Greek playwright Euripides said it best: “Silence is true wisdom’s best reply.” In dealing with death and death’s journey, High-TQ Hospice Triage Nurses know when silence is okay, or even best. The moment of death, family member’s loud or silent grieving, Kübler-Ross’s denial and anger stages of grief squarely directed at you — These are times to breathe deep and find your friends’ silence and compassionate touch. The same is true if we are ever asked anything we do not know the answer to. “I don’t know” is raw truth. Finding, then sharing the answer is bountiful truth.

‘We recognize options
in terms of curative and comfort treatments
and carefully, respectfully, dutifully communicate these options to patients and caregivers.’

10. BALANCED

The trait of being balanced is essential. Many of these other traits on this short-list of “High-TQ” Hospice Triage Nurse characteristics allude to this fact.

  • The science of nursing/the art of nursing
  • Being tough/showing compassion and vulnerability
  • Non-authoritatively being an authority
  • Tenderly taking charge and lovingly guiding through the dying process
  • Listening/communicating/being silent

Being a Triage Nurse is tough. But it is part of why we love and answer the calling, and why others love us for it – even if they are never able to show it.

February 22, 2022 by carexm Leave a Comment

Filed Under: LIFE OF A TRIAGE NURSE Tagged With: Art of Nursing, home health, Home-Health, hospice, nurses, supporting nurses, Triage Nurse, Triage RN

Filed Under: CHANGE AGENT Tagged With: home health, hospice, medical answering service, nurses, supporting nurses

How Savvy Providers Should Plan for Consolidation, Nurse Burnout, BI, RPM, and the Quadruple Aim.

The COVID Pandemic has doused decades-long global healthcare burnout with gasoline – then lit a match.

At a time when systemic fatigue and clinical and nonclinical workforces alike have traditional healthcare begging for the reset button, here we are, at the close of the first month of 2022.

In many ways, those of us in Home-Health and Hospice are in a sweet spot. In great part, we are exempt from many of the trappings burdening bricks-and-mortar operations. And while it may not always feel like it, We operate out of the reach of some regulatory burdens and broad-swath attacks associated with the pandemic. The silver lining is there, and CareXM is here to help you find – and keep – it. CareXM’s team of home health and hospice nurses built an easy-to-use, industry leading patient engagement platform with 24x7x365 nurse triage and remote monitoring for patients, caregivers, and staff. As we shift to value-based care models, we are seeing new trends and new innovations arise to elevate the patient and care provider experience.

Here is our short-list of trends transforming care we see impacting our business of care in 2022.

THE QUADRUPLE AIM OF HEALTHCARE

2022 will be a year of continuing transformation of what started in 2008 at the “Triple Aim of Healthcare.”

Former Medicare/Medicaid executive Dr. Don Berwick led the charge with the initiative, to improve population health while also improving The Patient Experience and lowering costs.

The Quadruple Aim gives us the opportunity to not only improve Patient Outcomes and Patient Experience and reduce healthcare costs, but to swiftly, surely address our current healthcare crisis: Elevating the Clinician Experience.

CareXM partners are uniquely equipped to tackle these challenges. By streamlining triage, patients access care more quickly and cost-effectively, improving their outcomes and experience, while reducing healthcare costs, and alleviating pressure on their clinicians.

CareXM clients credit us for helping them to execute on the Quadruple Aim initiative. After
engaging CareXM as a partners, one hospice was able to convince a burnt-out clinician to return after resigning (Hospice of the Northwest). Goshen Home Health and Hospice credits CareXM’s services contributing to accomplishment of zero turnover.

Diagram

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BUILD BACK HOW?

HHH enjoys bipartisan confidence from policy makers as an effective setting to reduce healthcare costs system-wide.  CMS, for example, credits HHH with $3.5 billion in savings when patients are placed in the HHH setting versus skilled-nursing facilities and other post-acute options. 

In 2022, expect to see more creative policy making. Ideally, we will move beyond the politicized 2021-attempted, $1.9 trillion “Build Back Better” legislation. Although it included $150 billion in sweeteners for HHH, the policy bogged with other areas of social spending.

Additionally, look for an uptick conversations about reimbursement for Telehealth and RPM technologies in this setting.

2022: CareXM's Take on Home-Health & Hospice | CareXM
“BI Meets Healthcare” is a trend for 2022. Savvy HHH admins seek ”actionable data” versus emotion to drive decisions about case management and after-hours triage. Having BI from CareXM is like having another bright mind (with an eidetic memory) in your management meetings..
Source: Yan Krukov, Pexels – Photo by Yan Krukov from Pexels

BUSINESS INTELLIGENCE MEETS HEALTHCARE

2022 will be the year Business Intelligence (BI) meets Healthcare.

In healthcare, we are accustomed to “business as usual.” This dulling of our business sense often renders us unable to surface the questions to ask about our business operations. This includes a deeper understanding of our after-hours ops and other big-picture items. Business Intelligence or “BI” takes the emotion out of decisioning and provides actionable data.

CareXM will continue to share case studies. These case studies explain how leading-edge clients like Providence and Hospice of Chattanooga are transforming the patient experience with BI.

TELEHEALTH, RPM PROGRAMS AND TECHNOLOGIES

COVID and its new fourth wave have informed us of our strengths and weaknesses. One silver lining, surely, is that the telehealth floodgates have opened. McKinsey reports that telehealth has increased 38-fold since the dawn of the pandemic.


Telehealth and Telenursing are here to stay – and not just “stay” but continue to see explosive growth and continuously innovative applications that change how traditional medicine is performed. Ever bullish on Telehealth, McKinsey foresees $250 billion in healthcare moving to virtual healthcare. Telehealth will move beyond basic care to integrated, chronic-disease management.

In 2022, RPM moves up on savvy administrators’ near-term planning agendas. There are currently 50.2 million patients being remotely monitored in the US. As tech-savvy Millennial and Generation X caregivers come to the aid of aging Baby Boomer parents and family members, RPM will become not just an occasional luxury, but an expected level of service. Look for RPM to swiftly move from occasional to entrenched for HHH operations, as the industry looks to become nearly a half-billion dollar industry within five years.

Look for 2022 RPM product announcements and delivery from CareXM.

VALUE-BASED CARE CONTINUES TO GAIN TRACTION

Keeping people well – what we in HHH want – will continue its virtuous steamroll to change the way we are compensated. With the late 2021 approval The U.S. Centers for Medicare & Medicaid Services (CMS) released the 2022 home health final payment rule.

This offers a significant business-development opportunity for HHH to partner with hospitals and other referral sources to decrease readmissions, increase satisfaction, and grow revenue.  

COMMUNICATION ELEVATED

2022 is the year of “Communication Elevated.” HHH patients and caregivers need “bat phone-level of communications” with clinical services. The comfort of home, with the added comfort of a nurse-call button at what will become the Hospital at Home is what the Patient Experience, the Caregiver Experience, and the Clinical Experience all demand.

This applies to during-business and after-hours access.

Patients and caregivers insist on rich media delivery, paired with back-end protocols to ensure effective care and use of resources. “HIPAA-compliant” becomes a given for medical data exchange.

HOME IS WHERE THE HEALTH IS FOR ‘THE SILVER TSUNAMI’

AARP now has an entire website dedicated to The Center for Aging in Place. 

Mid-November’s AARP survey data shows 77% of seniors age 50 and older want to age in place. (Other sources peg this number even higher – at 90% of American’s age 50+.)  Decades of AARP data demonstrate commitment of these older adults  to the home. It is commitment to the home as a sacred space and delivery system for living, healing, and, ultimately, transitioning through the dying process.

“The Silver Tsunami” as we know is a 1960s-borne metaphor for the wave of Baby Boomers and the country’s fastest-growing population being its “oldest old.”   Americans in specific and humans in general are living longer. Right now, 15% of Americans are 65+. The Tsunami, tidal-waving our traditional healthcare system, will continue to swell with 25% of Americans being 65+ by 2030.  A full 92% of these seniors has at one serious chronic condition and 52% has two or more chronic conditions.

It is our honor, duty and opportunity to transform our healthcare system.

CONSOLIDATION OF BIGS, DECLINE IN MOM AND POP DOC SHOPS

“Mega-Mergers” is the word observers use to describe the 2021 healthcare market.

We augment that trend with noting the shift in closures of private medical practices.

As reported by the AMA this spring, the number of private physician practices is down. Less than half of physicians responding to AMA inquiries indicate working in practices owned by physicians. This represents a 5% decline since research gleaned two years prior.

In 2022 CareXM will target services specifically for independent practitioners. 

CareXM will also expand clinical/non-clinical and “hybrid” services for a variety of new aspects of the care continuum. 

2022: CareXM's Take on Home-Health & Hospice | CareXM

Billboards in Victoria, Texas let consumers know how long it takes to be seen in the ER. In 2022 CareXM clients can access data benchmarking their results compared with thousands of other results.

RETAIL CARE: MAKING A PLAY TO STAY RELEVANT

Brick-and-mortar retail is seeking to stay relevant through expansion into healthcare services.

CVS and Target have brokered deals to provide physician services through 1,000-plus MinuteClinics housed within retail stores. Walgreens is partnering with VillageMD to provide 600 locations across the country.
Rating systems beyond CAHPS will become increasingly more important. Not just referral agencies but patients and caregivers themselves are wanting the information. 

Online reviews, such as those from Google, will be supplemented by private-system reviews (such as those from Providence Health).

In 2022 CareXM customers will be able to generate very specific competitive marketing information. They will be able to comparatively benchmark – and then creatively market – their own operation’s after-hours performance.

The challenge and opportunity is understanding this landscape, embracing and fortifying our unique role within the care continuum. 

Forbes summed it up well: “Consumers expect convenience, ease of access and quick responses.” Pundits added this mindful editorialization: “Not necessarily the features traditional healthcare delivery is known for.”


2022: CareXM's Take on Home-Health & Hospice | CareXM

Aspire Home-Health and Hospice actively leverages Google ratings in its digital-marketing campaigns. In 2022 CareXM customers will be able to market benchmarked data for their specific performance in key areas. 

THE HOME HOSPITAL?

The Home Hospital may be nigh. 

Analyst Kaufman Hall indicates hospitals are increasingly seeking diversified business models. The consultancy suggests significant creativity with regards to Home-Health and Hospice, Palliative Care, Telehealth, and other strategies. There is an active hunt toward “identifying strategic partnership with payers, physicians’ groups and other adjacent sectors.”

However, one clear challenge we will face in moving more acute patients to a home hospital model in the requirement sophisticated remote patient monitoring, and agile care response models. CareXM will provide ongoing information about this trend for 2022.

2022: CareXM's Take on Home-Health & Hospice | CareXM

CareXM’s earliest client, Bristol Hospice, emphasizes providing “Specific and unique levels of care,” says Roy Backus, Executive Vice President of Community development for the 25-location hospice. The LOC, he says, is “above and beyond what the Medicare conditions of participation require.”

COVID, VACCINATION  AND COVID-FUELED BURNOUT – STILL THREATS TO HHH AND HEALTHCARE IN GENERAL

Look for Covid to continue to be a presence, with the U.S. Supreme Court handing down split rulings for vaccination requirements. Large employers are exempt, but healthcare workers at government facilities bear a vaccination onus, according to mid-January Court rulings. Look for ever-intensifying healthcare workforce fallout accompanying these mandates.  

The Vax/Anti-Vax Divide will continue to be an issue in 2022. The vaccine issue will drive already spent clinical and non-clinical workers to other, non-frontline positions. Or when no desirable opportunities avail themselves, long-term clinical and administrative staff will continue to leave the field in droves as career-changing Great Resignationists.

American psychologist Herbert Freudenberger posited the term “Nurse Burnout” in 1975. Only recently have healthcare organizations, policy makers, and the media recognized burnout as a global crisis. The impact will continue to be profound for HHH, where clinical roles are already prone to burnout. 

2022: CareXM's Take on Home-Health & Hospice | CareXM

CareXM’s longest-term client, Bristol Hospice, leverages the Vimeo platform to successfully attract clinical and non-clinical candidates alike, amid the global crisis of care. Promotional videos for after-hours RNs are offered in both English and Spanish.

THE UNIVERSAL CRISIS OF CARE

Clinical burnout is not just American in nature. It is a global issue. 

NAHC President William Dombi cited the societal impact of care in his 2022 “crystal ball” presentation. It is not a compartmentalized concern for patients, caregivers, payers, and providers, but for us all.

In 2020, the PwC Health Research Institute indicated 94% of provider executives branded  “improving the clinician experience” as a top priority for 2021.

That figure is 100% for 2022.

CareXM’s focus on – and proven formula for – The Quadruple Aim of Healthcare is positioned to help HHH retain long-term and new-entrant employees and shore up your ability to provide work-life balance and actively, daily show your employees your commitment to leading-edge technology as part of the Quadruple Aim.

2022: CareXM's Take on Home-Health & Hospice | CareXM

Bristol Hospice Executive Vice President/Chief of Quality, Jeannette Dove, MFCS, started her career as a hospice case manager and finds CareXM’s clinical expertise and insights incomparable to other providers’ offerings.

‘THE CLINICIAN FACTOR’ – WHAT DISTINGUISHES ‘PARTNERS’ FROM VENDORS 

In 2022 savvy administrators will recognize the difference between mere vendors and true partners.

They will recognize salespeople pushing standalone products versus partners buoyed by clinician savvy and technical integration teams presenting value-added solutions.


The definitive pioneer and leader in “solutions partnering” to HHH, CareXM will shortly announce our new consulting practices which will continue to help our existing clients thrive and encourage more to come on board.

2022: CareXM's Take on Home-Health & Hospice | CareXM
CareXM is laser-focused on providing clients with a hybrid model of technology and clinician-informed protocols. Our partners tell it best: ”The CareXM difference is not available elsewhere in the industry.”
Photo by Anastasia Shuraeva from Pexels

SOLVE, DON’T SELL –  SWAS VERUS SAAS

SAAS or “Software As a Service” bows to the richer, necessary “Software With a Service.” Non-consultative, non-clinician-informed IT-based software does not fit the bill for HHH. 

2021 IN REAR VIEW, FAST-FORWARD WITH CareXM

In 2021 CareXM aligned three major companies: Telemed (nimble, best-of-class 24/7/365 clinical, non-clinical answering service), Total Triage (technical telephony backbone, phone app), and TouchPointCare (RPM, Patient Engagement).

This month we are doing what we will fully embrace throughout 2022: This is our flagship year with an aligned, fully built, laser-sharp focus. CareXM is uniquely positioned to transform healthcare. CareXM is working to be – and, as in the case with many of our clients, will remain remain – your ideal partner for decades. Our offering is “hybrid” clinical and non-clinical services, anchored by our communications platform and  Remote Patient Monitoring (RPM) programs and technologies.

CareXM leadership nails our offering: “Our largest customers need all three opportunities, rolled together as a seamless experience.

“It is a seamless experience for the patient, the caregiver, and our customers’ staffs.”

We seek to delight customers in terms of services and software.

Let’s best welcome the New Year by releasing emotional exhaustion and being ready, rejuvenated, resilient.

THE INVITATION: PARTNER WITH CareXM

The invitation to you is to do more than read – but provide your insights. Call us or jot thoughts at the close of this article.

February 3, 2022 by carexm Leave a Comment

Filed Under: CHANGE AGENT Tagged With: home health, hospice, medical answering service, nurses, supporting nurses

Filed Under: Appointment Scheduling Tagged With: answering service, medical answering service, nurses, supporting nurses, telehealth

In this turbulent and difficult world that we are all still navigating, it is important to serve respect where respect is due. There are many healthcare professionals doing all in their power to help those that are sick and afflicted. Despite all the safety protocols that are in place, nurses are still putting themselves in harm’s way to help other people. It is imperative to do what we can to be there for our nurses. There are many ways that you can help and support nurses and the other healthcare workers in your life.

Help Out With Home Tasks

While nurses may at times need to keep their distance from their loved ones to protect them, there are things you can do to literally and figuratively be a shoulder for nurses to lean on. Offer up your help to watch a nurse’s child or bring a hot meal by. With the long and erratic hours, nurses may worry about their children’s wellbeing and most likely have not seen a good meal for a while. The key here is to be a friend to the nurses in your life and understand that this time is busy, hectic and stressful for them.

Volunteer

How to support nurses

One of the best ways to help and support nurses is to volunteer. Volunteering at the local hospital or at the Red Cross is a great way to support nurses if you have a free day off or just want to find somewhere you can be of use. Volunteers play a crucial role in making sure that the nursing staff is able to provide the best care to their patients. Be flexible and willing to take on different tasks that are assigned to you. You may run errands for the nursing staff, do clerical work, or simply sit and spend time with patients. Really anything that you do will be useful to nurses as they try to keep up with the many demands that are placed on them.

Donate Plasma

Another great way to support nurses is to donate plasma. There are about 4.5 million Americans a year who need blood and only about 37% of the United States population is able to donate blood. The reason why it is helpful to nurses to donate blood is because it allows them to be able to do their jobs, not to mention that it helps many people who are in need of blood transfusions.

Be An Emotional Support

If your loved one is a healthcare worker, it is likely that they are going through incredible stress at this time. Even in a world where Covid-19 did not exist, nurses have one of the hardest jobs in that they have extremely long shifts that are at all hours of the day and night. This can lead to burnout. Support your nurse by being there when they need to talk, let them sleep when they need to, and be supportive of self-care practices that they have. Let them know that you love them and that you will be there for them if they need you.

How We Support Nurses

Here at CareXM, we make it our business to service and support nurses and other caregivers. As a telehealth company with many different answering services available to those in the medical field, we offer nurses relief in a way that many companies cannot compete with. We will answer calls, speak with clients and reply to any customer questions so that nurses don’t have to. If you are a nurse or know a nurse, consider CareXM as an option to help make life easier. Contact us today for more information or to learn how to build the perfect contact center service plan for your needs.

September 4, 2021 by carexm Leave a Comment

Filed Under: Appointment Scheduling Tagged With: answering service, medical answering service, nurses, supporting nurses, telehealth

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