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Efforts of health plans to balance service quality with cost control have spurred rapid growth in telephone nursing advice services. Service system design can affect costs, patient outcomes, and staff retention. Research has not addressed how the organization of nursing services affects practice outcomes in telephone advice settings. We describe observed variations in telephone advice nursing services and the organizational and process factors the nurses identified as supporting or hindering their work.

Caller descriptions and evaluations of their experiences with telephone advice services provide unique information that correlates highly with objective measures of quality and can help interpret data from other sources. An author-developed questionnaire assessed caller outcomes of telephone nursing advice in Phase I an iterative, purposive sample of 40 callers was interviewed by phone. An emergent design was used to develop questions, analyze constructs of interest, and test questions for a draft caller questionnaire, which was tested in Phase II. Responses to the questionnaire provided information about caller characteristics, advice call characteristics, and nurse practice behaviors that caused the authors to further revise the questionnaire. The resulting tool provides feedback to advice nurses about the outcomes of their practice and information to design orientation and development programs and support fund allocation decisions.

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