Journal of nursing management · 2026
"Stay Calm and Pick Up Signs to Understand the Cause": Registered Nurses Use Multiple Strategies for Handling Difficult Emergency Calls.
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Holmström Inger K, Blomberg Hans, Winblad Ulrika, Spangler Douglas
Аннотация
BACKGROUND: Telephone triage at emergency medical dispatch centers (EMDCs) is often challenging for registered nurses (RNs), and some calls may be difficult to handle. To enable education and interventions for call-taking RNs, lessons can be learned by studying authentic calls.
AIM: The aim of this study was to describe the strategies used by RNs in difficult calls to EMDCs.
METHODS: Call data from 2022 to 2023 were extracted for 14 RNs at three EMDCs in Sweden. Difficult calls were identified based on prior research and operationalized primarily using keyword searches in the free text call notes. During the study period, the 14 RNs handled 27,805 calls. Of these calls, 4888 (17.6%) were identified as potentially difficult and RNs needed to apply different strategies to handle them. A purposive selection of 123 calls was extracted, anonymized, and a deductive content analysis was performed.
RESULTS: The present RNs used eight strategies to handle difficult calls. The most used strategies among the 123 calls were "pick up signs to understand the cause of the caller's problem" (used in 76% of calls) and "stay calm and focused" (55%). It was common that RNs applied several strategies during one call, especially if the call was about psychiatric illnesses, including expressions of suicidal intent and calls with vague descriptions of symptoms. Single strategies were used in 20% of calls, combinations of two strategies were used in 50% of calls, while three or more strategies were used in 29% of calls.
CONCLUSIONS: RNs typically used combinations of several strategies in handling difficult calls. It is, however, unknown if these strategies were the most appropriate and how they were experienced by callers.
IMPLICATIONS FOR NURSING MANAGEMENT: RNs need continuous professional development, support from nurse managers and their organization, and further improvements in technical aids to support their handling of difficult calls.
AIM: The aim of this study was to describe the strategies used by RNs in difficult calls to EMDCs.
METHODS: Call data from 2022 to 2023 were extracted for 14 RNs at three EMDCs in Sweden. Difficult calls were identified based on prior research and operationalized primarily using keyword searches in the free text call notes. During the study period, the 14 RNs handled 27,805 calls. Of these calls, 4888 (17.6%) were identified as potentially difficult and RNs needed to apply different strategies to handle them. A purposive selection of 123 calls was extracted, anonymized, and a deductive content analysis was performed.
RESULTS: The present RNs used eight strategies to handle difficult calls. The most used strategies among the 123 calls were "pick up signs to understand the cause of the caller's problem" (used in 76% of calls) and "stay calm and focused" (55%). It was common that RNs applied several strategies during one call, especially if the call was about psychiatric illnesses, including expressions of suicidal intent and calls with vague descriptions of symptoms. Single strategies were used in 20% of calls, combinations of two strategies were used in 50% of calls, while three or more strategies were used in 29% of calls.
CONCLUSIONS: RNs typically used combinations of several strategies in handling difficult calls. It is, however, unknown if these strategies were the most appropriate and how they were experienced by callers.
IMPLICATIONS FOR NURSING MANAGEMENT: RNs need continuous professional development, support from nurse managers and their organization, and further improvements in technical aids to support their handling of difficult calls.