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Since April 2001, telenurses have been fielding calls from all over British Columbia, giving callers health information and providing a telephone nursing triage service to those B.C. residents who arent sure what level of health care they need for a particular condition or health concern. It was late on an October evening and Jack was increasingly worried about his son, Aaron not their real names.

The three-year-old boy had been sick for several days and seemed to be getting worse. The local clinics were closed and Jack fortable waiting until morning to have his son assessed, so he decided it was time to take him to the emergency department.

He called the hospital to speak to a nurse to confirm that Aaron needed to go in. However, instead of speaking with him about his sons condition, the nurse gave him the telephone number for the BC NurseLine.

This was Jacks introduction to a new British Columbia health care service. BC NurseLine is British Columbias first significant foray into telenursing.

It is part of the integrated BC HealthGuide Program. BC NurseLine is a telephone triage, information and advice service, staffed 24 hours a day, seven days a week by a team of specially trained registered nurses.

A Unique Nursing Practice Environment Although registered nurses in public health units, emergency departments, physician offices, clinics and other settings have been providing advice and information to clients over the telephone for many years, it has usually been an informal practice. In the past, most of these registered nurses received little or no training for assessing and advising clients over the telephone, and the calls they received were rarely documented.

In recent years, however, there has been increased recognition that assessing and advising clients over the telephone can be a difficult and risky undertaking. Nevertheless, changing health care needs and a growing public demand for timely access to health information and advice has resulted in the expansion of formal telehealth services around the world see the article Telephone Advice in the June 2003 issue of Nursing BC, also available online at by clicking Members Nurses, Nursing Practice, Practice Documents.

The difficulty in providing care over the telephone has necessitated the development of standards to ensure safe and consistent practice. The BC NurseLine policies, procedures and protocols have been based on standards for telenursing practice developed by the American Academy of Ambulatory Care Nursing and by the American Accreditation mission.

Because telenursing is a new and evolving nursing role in B.C., there is ongoing development and modification of policies, procedures and protocols to address specific needs identified within the provincial call centre and the B.C. health care environment.

Moreover, all policies and procedures are reviewed regularly to ensure that they are consistent with RNABCs Standards for Registered Nursing Practice. The BC NurseLines standards for telenurses practice will be reviewed in future by the Ministry of Health Planning with RNABC following publication this fall of the National Initiatives for Telehealth Framework of Guidelines.

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