Nursing research: How can we better support triage nurses?

Triage nurses on the frontlines of the COVID-19 pandemic are charged with making complex decisions as patients call in with lists of symptoms and nurses work to ensure that patients receive timely and appropriate care, which may require being seen in person or monitored differently.

This balancing act is further influenced by the reality of working with a previously unknown virus, which results in often changing guidelines and resources to guide care, and the concern of overburdening hospitals and clinics – all the while recognizing the potential consequences related to the spread of the pandemic and individual patient outcomes.

Élise Arsenault Knudsen, PhD, RN, ACNS-BC, is a co-investigator at UW Health for a multi-site study to better understand and model how nurses make triaging decisions during the COVID-19 pandemic.

“We’re interested in how nurses are making decisions and what resources are available to them in their work environment to guide their decision-making,’’ says Arsenault Knudsen.

She was invited to join the study by colleagues at the University of Iowa, including principal investigator Priyadarshini Pennathur, PhD, and co-investigators, Laura Cullen DNP, RN, FAAN, and Stephanie Edmonds, PhD, MPH, RN. The study team has received funding from the National Science Foundation (NSF) through a rapid response research grant to explore what resources nurses use for decision-making, understand the cognitive work of triage nurses, and how nurses’ perception of risk influences their decisions during a pandemic.

After attaining Institutional Review Board (IRB) approval, the researchers plan to use transcripts of phone calls during the peaks of the COVID-19 pandemic and analyze non-clinical data from those calls. They also hope to use screen capture technology to show which resources nurses use, and likely toggle between, to guide their decision making. They will then interview between 40 and 60 triage nurses at UW Health and the University of Iowa to understand their cognitive process and their perceptions of risk.

“Our goal is that once we understand how decisions are being made, we can design tools to help facilitate decision making and better support our triage nurses,’’ she says.

Arsenault Knudsen is the clinical nurse specialist for research and evidence-based practice at UW Health. Her job is to support nurses across the healthcare system to do research and to use research evidence in their practice. Her program of research explores ways to support nurses to change their practice, while accounting for the dynamic context in which nurses work, to optimize patient outcomes.

She says during the COVID-19 pandemic, she has seen research the timelines for research accelerated, including at UW Health.

“Traditionally research studies take months and even years to get off the ground, but NSF funded us in a matter of weeks and the approval processes, including the IRB, are moving at lightning speed,’’ she says.

UW Health is a site for multiple clinical trials involving COVID-19 treatment, which means nurses are not only caring for these patients, but they are also supporting research protocols that will help us to learn more about how to treat them.

“It’s been fascinating to see how quickly studies are getting up and running, patients are being enrolled, and the teams are coming together to accelerate knowledge and treatment for patients here, and all around the world,’’ she says. “These nurses are doing amazing things.”