IQ… EQ… and TQ?

February 22, 2022

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

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.

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 10, 2022

Valentine’s Day speaks with a unique voice to those of us servicing HHH (Home-Health and Hospice), taking triage calls via remote triage nurse jobs or a medical call center.

Telenursing Triage’s Take on Feb. 14 — *Love is truly the theme for patients and family, family caregivers, and all involved in home-health care and hospice services.*

Valentine’s Day is inspired by caregiving or healing. Its main symbol is documentation of that love – the less clinical and certainly more commercial version of it anyway – via cards, letters, notes, etc.

Both of these correspond to the daily love stories we see and sometimes participate in as part of directing 24/7 nurse triage phone calls serving homecare health services and hospice triage.

Add to this the fact that traditional Valentine candy “conversation hearts” were designed by a pharmacist, and we have made the case that St. Valentine’s Day truly is an HHH holiday! (FYI, Oliver Chase, the pharmacist inventor was initially solving manufacturing issues with medical lozenges. When Eureka – One small step for care lead to today’s 8 billion annual candy-heart production – and a distant echo to the documentation of love, supposedly between a patient and a healer.)

ST. VALENTINE – MAN OR MEN? PHYSICIAN PRACTICES, OTHER CONTRIBUTIONS

Researchers cannot agree whether St. Valentine was one, two, or even three individuals.

What is known, however, is that this individual or these individuals cared for the afflicted, providing triage services in third-century Europe.

In one version,

Valentine, smitten with the once-blind Julia,

penned her a love letter,

signed “from your Valentine” on the very day of his execution.

In the other version,

it is Julia, now able to see and write,

who inked the love letter to Valentine.

For the Triage Nurse,

the notice of pure care in a non-romantic sense

is the memorable takeaway.

Valentine is known to have provided triage care to those with Epilepsy and the Black Plague. We do not know how much of his/their capabilities came from medical smarts, faith, luck, or lore, but his/their example is famous all the world over.

Legend has it that Valentine restored sight to the blind daughter of a jailer. Julia’s father generously and – quite publicly, indeed overly publicly – rewarded Valentine by freeing the healer and other confined Christians. The new convert shepherded the conversion of 50 members of his family to Christianity.

It was a costly tribute. The emperor of Rome demanded the beheading of Valentine and his greatest convert. February 14 both Valentine and the jailer were executed.

LETTERS OF LOVE? INSIGHT FOR MEDICAL CALL CENTERS?

Smithsonian researchers scoff at any notion of romantic love’s being associated with St. Valentine.

Legend tells it two ways:

In one version, Valentine, smitten with the once-blind Julia, penned her a love letter, signed “from your Valentine” on the very day of his execution.

In the other version, it is Julia, now able to see and write, who inked the love letter to Valentine.

For the Triage Nurse, we vote with the Smithsonian: The notice of pure care in a non-romantic sense is the memorable takeaway.

BEING TODAY’S VALENTINE AS TELEHEALTH NURSING STAFF

Today, more than 145 million Valentine’s cards are penned annually and 8 billion candy hearts deliciously present their mini-missives of love and caring.

For those of us RNs in triage nurse jobs, Valentine’s Day is another day of giving of ourselves and being rewarded for our role. These are, of course, health and hospice roles where patients are being treated, family members and caregivers are doting on loved ones, and clinical and non-clinical staff members are bringing our all to each present moment.

CareXM Nursing Manager Kelli Hall has worked for years as a remote triage nurse from Pearcy, Ark. Before joining CareXM in a telephone nurse triage job almost five years ago, she was a Hospice Program Director for the then 500+-census Arkansas Hospice, which is celebrating its 30th anniversary this year as Arkansas’s largest nonprofit provider of hospice care.

Flourishing child-like joy, Hall and her team would make Valentine’s Boxes from well-loved items ready for re-imagining. Outside judges honored best-in-class entries. Nursing-home patients, IPU patients, and the homebound received hand-crafted boxes stuffed with cards, candy, and chocolates. A chocolate fountain, local vendors’ donated bakery treats and fresh-flower bouquets for loved ones sealed the special holiday.

FEB. 14 WHILE WORKING NURSE TRIAGE JOBS FROM HOME

Each year, Valentine’s Day for me invokes memories of a caregiver’s decades-long love for his spouse.

He contacted the on-call service for telephone triage, distraught about his wife’s level of pain. He helplessly wrestled with his knowledge: He knew that morphine was the right treatment but was terrified of it. He knew that administering morphine would turn the corner and come closer to his accepting her imminent demise.

We talked for about five minutes, following hospice triage protocols. He trusted me, as a phone triage nurse and as a caring coach.

He grieved, acknowledged, and ultimately, accepted coaching for how to, at that moment, show the most love to his greatest love.

In so doing, he accepted her continuing journey and his unique role in helping her receive the most comfort, the greatest love possible on her way toward death. Once on her morphine drip, her tense face eased, her serenity returned. He cried with joy and acceptance.

My colleague and inspiration is Kristy Fisher, our Director of Nursing at CareXM. While serving as a hospMy colleague and inspiration is Kristy Fisher, our Director of Clinical Operations at CareXM. While serving as a hospice triage nurse and then a clinical director for a hospice, she used to collect tributes she received from patients who had passed away but credited her caring in their obituaries. These love letters from beyond the grave document the importance of care and are a faint tribute to someone named Valentine and the many ones he loved and cared for.