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What is a Telephone Service Nurse?

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This week we had a chat with Carol, an experienced telephone service nurse, who has worked as a clinical nurse for the 111 non-emergency NHS line as well as for a crisis telephone service as a mental health nurse. Carol shared some fascinating insights into what it is like working as a telephone service nurse. We discussed future career prospects, as well as some of the reasons why telephone service nursing is such a vital sector for modern-day health care.

Thank you for taking the time to speak with us during a busy shift, Carol! Can you tell us a little bit about your current roles with the crisis telephone service and the 111 NHS line?

Absolutely. I work as a mental health nurse for the crisis telephone service in a London borough. In this role we are dealing with people that call in that are in crisis – people who are either having suicidal thoughts, have made plans to self-harm, or are in need of support during a crisis.

If you lived within my area and called the crisis team, you would come through to me. Whilst speaking to a caller, what we do is screen the calls and make the appropriate referral. If somebody says ‘I feel suicidal, I have a plan I’m going to jump off a bridge’ I would call the ambulance service (who I also work for sometimes) and dispatch paramedics and sometimes police depending on if there was any aggression or a weapon involved.

“The role that we do here is really powerful: we are able to build a rapport with somebody that we’ve never spoken to before, and are able to deescalate their crisis. I’ve talked people down off of bridges, off of train tracks. If you feel that you have a gift to be able to help people, then go ahead and help people. The job is so rewarding.”

I also work as a triage nurse for the NHS 111 non-emergency number – this service is for giving medical advice for a wide range of issues. The increase in number of people using this service now is huge, which has been fascinating to be a part of.

What made you decide to go into telephone service nursing?

The move I made away from patient facing nursing was for my family – I have a family member who is at high risk during the height of the pandemic due to health condition and being of the BAME community. At the time, I didn’t feel the safety provision available for staff in patient facing roles was strong enough for me to feel safe bringing anything to my family.

I have to say, that the staff that are in patient-facing wards are absolutely amazing and we couldn’t support our patients without them. The safety provision for staff has improved a lot now too. However, if you have a family member who is high risk or if you are vulnerable yourself, I would say look for a role that isn’t patient facing. There are more options out there than you might think. I would recommend telephone service nursing as a valuable option. I find that a lot of the older generation of nurses aren’t necessarily aware that these roles are available, so let’s spread the word!

What was it like working through the pandemic as a 111 / emergency line mental health nurse?

It has been incredibly busy! Although that comes with a huge sense of satisfaction, knowing the number of people that we are now able to help. There has been a huge influx of calls over the past year. The demand for the services has absolutely skyrocketed. For a while, we were permitted to work from home for a few days a week, but the roles our now fully office based. Being close to the team is a really important part of the role though. There is a real wealth of experience and knowledge in the room and we are always learning from each other.

What does your working week look like?

Our shift times are 8:00-16:00, 12:30 – 20:30 with a couple of 12 hour shifts of 8:00 – 20:30.

How does the 111 role differ from the emergency line? We’d like to give our readers a sense of the most suitable role for them.

With the 111 non-emergency service the demand is much higher, we will have 50, 60, 100 calls queueing with our team at times, whereas with the emergency line there would be around five or six calls queueing during the busiest periods.

With the 111 service, you have time targets to work towards. These don’t apply to the crisis line due to the nature of the calls.

It’s useful to be adaptable to the role you take on. For example on a busier 111 shift, you’ll need to be someone who can work under pressure and change tact quite often due to the sheer volume of different people and issues you’ll be dealing with each day. Some people really thrive on that. Whereas, when it’s less busy it’s important to use that as an opportunity to spend more time with the person you are speaking to, and to give them that extra care and attention.

Regardless, when it’s a mental health call I will take as long as I need I’m not going to rush that call because that person is crying out for help. When I know I can help someone, I will.

What characteristics are important to be an excellent telephone service nurse?

Most importantly, active listening skills. When you are a mental health nurse, it’s very important that you listen. People who are in crisis, they often feel that they are not being heard or they are not being listened to. So regardless of what a person is saying to you – they could be saying that the sky is pink – I am giving them my undivided attention that the sky is pink.

By doing that, by reaching a level of common ground with the caller, they will start to give you more information, enabling you to uncover the real issue. Whereas, if you are dismissive or impatient with somebody, saying something like ‘oh, don’t be so silly the sky is blue’ then the caller is likely to shut down and won’t want to open up to you.

That must be incredibly rewarding when you know that you’ve helped someone?

The role that we do here is really interesting and powerful: we are able to build a rapport with a person that we’ve never spoken to before, and are able to deescalate their crisis. My team here is amazing. You have to give your undivided attention to the person who has called you.

I’ve talked people down off of bridges, off of train tracks. If you feel that you have a gift to be able to help people, then go ahead and help people. The job is so rewarding.

Somebody has called and they’ve said they want to end their life and they have a plan, but end the call saying ‘You’ve really talked me down, thank you, you don’t know how much I appreciate you taking the time to listen to me.’ Hearing this always touches my heart, I really do love being a mental health nurse.

That must be a hugely challenging role at times with a lot of pressure. How do you cope with that yourself?

The good always outweighs the bad. When I come into work I keep my ‘clinician’ head on and it’s very important that nurses debrief or distress before leaving to go home. Even if you receive a really stressful or traumatic call, you have to leave it there. I have the ability to do that, but for others that can be quite difficult.

It’s a skill that you can learn, to make sure you don’t take your work home with you in that respect and ruminate on negative thoughts too much.

The role isn’t for everybody – you need to find your niche. This is why it’s so useful to explore the variety of roles out there. Talking to the consultants at Prospero really helped me make sense of what I wanted to do.

For those that may not have thought of telephone service nursing before as an option, what career opportunities can these roles provide?

I was selected for the leadership and scholarship programme with a QI project, which I’m going to use NHS111 as my focus for the role. This will help me move up from band 6 pay grade to band 7 or 8.

Most telephone service nurses are on the band 6 pay grade. You can progress and become a clinical lead. This way, you can also progress within the band 6 scale, but also jump up to band 7. This involves taking on more responsibility so you should look really carefully what that involves, making sure you’re comfortable within that remit.

We have heard that the demand and awareness of these services has increased dramatically recently. What is the future of telephone service nursing?

I have worked for the 111 NHS service since 2011. It was perhaps not used so much pre-pandemic, as the awareness and trust in it maybe was not there amongst the general public. During a 10-hour shift, colleagues would sometimes take a handful of calls per day (back when it was called NHS direct).

That has all changed now! Currently, we are taking 30, 40, 60 calls a day – it’s absolutely amazing to see the growth.

I feel that this will continue to grow and there will be opportunities in this area. It’s never going to go away – people call us about everything. Our scope for supporting people and in turn helping our patient facing colleagues is massive. It is very exciting to be a part of!


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