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When most OB/GYN offices close for the day, Juliana Parker, RN, and her team are just getting started.
Their patients may be experiencing contractions, wondering whether they are leaking amniotic fluid, concerned about fetal movement, or trying to decide whether a headache during pregnancy warrants a trip to the hospital. Without the ability to physically examine them, the nurses must determine what information matters, what questions have not yet been asked and what needs immediate attention.
For Parker, founder of Nurse Core Triage, Inc., that makes after-hours telephone triage a job built around clinical judgment.
“Telephone triage is almost like detective work,” Parker said. “You have to listen not only to what the patient is telling you, but also know what questions they may not realize are important to mention.”
It’s a role Parker reached through an unconventional career that took her from labor and delivery to other areas of women’s health, education, telephone triage and eventually business ownership.
Today, her work offers a look at an area of nursing that patients may rarely see but that can play an important role in determining what happens between an after-hours phone call and the next step in care.
The Clinical Judgment Behind an After-Hours Call
Parker’s workday begins as traditional office hours end.
Her company currently provides after-hours telephone triage for four OB/GYN practices. Once coverage begins, nurses respond to patient calls throughout the evening and overnight until the practices reopen.
Nurses assess concerns using practice-approved protocols and their obstetric experience, determine the appropriate disposition, provide education and guidance, and decide whether further evaluation is needed.
Some nights are relatively quiet. Others become busy when multiple patients are in labor or several urgent concerns arise simultaneously. Early evenings tend to generate many calls, while Saturday mornings can also be particularly active because patients know their regular offices will remain closed for the weekend.
Among the most common calls are contractions, possible leakage of fluid, and blood pressure concerns during pregnancy. Nurses also field questions about medications, spotting, pain, fetal movement, postpartum concerns and breastfeeding.
The challenge is determining which symptoms require immediate evaluation, which can be monitored at home and which can safely wait until regular office hours.
When a Routine Call Isn’t Routine
One patient encounter illustrates why that assessment can matter.
A pregnant patient called because she was experiencing contractions. Based on the contractions alone, Parker said, her symptoms did not necessarily meet the criteria that would typically lead to an immediate hospital evaluation.
Then the nurse kept asking questions.
“However, as we continued asking questions, we discovered that she also had a persistent headache that was not resolving,” Parker said. “That additional piece of information changed the situation. Out of an abundance of caution and based on her overall symptoms, we directed her to the hospital for evaluation. She was ultimately found to have severe preeclampsia.”
For Parker, the case illustrates a central lesson of telephone triage: The reason a patient calls is not necessarily the most clinically significant information the nurse will uncover.
“Sometimes the most important information comes from the questions the nurse asks after the patient tells us why they are calling,” she said.
Elevated blood pressure during pregnancy is among the concerns Parker’s nurses take particularly seriously, especially when accompanied by symptoms such as a persistent headache or vision changes.
“One of the most important parts of OB telephone triage is recognizing that something that initially sounds routine can sometimes indicate a much more serious problem,” Parker said. “That is why thorough questioning is so important.”
Nursing Without the Bedside Assessment
Telephone triage removes something nurses typically rely heavily on: seeing the patient.
“One of the most difficult parts of telephone triage is that we do not have the patient physically in front of us,” Parker said.
Instead, nurses must listen carefully, ask targeted questions, follow established protocols and draw on their clinical experience to identify details that may change the disposition.
“There is a significant responsibility that comes with deciding whether a patient can continue monitoring symptoms at home or needs further evaluation,” Parker said. “It requires strong clinical judgment, attention to detail, and the willingness to keep asking questions rather than focusing only on the patient’s original complaint.”
For nurses interested in OB/GYN telephone triage, Parker considers substantial labor and delivery experience particularly important. Nurses also need strong listening, communication, critical thinking, and documentation skills.
What Happens After the Patient Hangs Up
One of the less visible aspects of telephone triage is how much work can happen after a call ends.
When nurses recommend hospital evaluation, they notify the on-call provider and the hospital charge nurse before documenting the patient’s assessment, recommendations, notifications and disposition.
“Documentation is extremely important in telephone triage because another healthcare professional needs to be able to understand exactly what the patient reported, what questions were asked, what guidance was provided, and what actions were taken,” Parker said.
Technology makes that coordination possible for a remote, after-hours nursing team. Nurses use a specialized phone application that allows them to return calls using the individual practice’s recognized phone number. Laptops are used for documentation, accessing practice-specific information and protocols, and coordinating communication.
By morning, the team is completing documentation and ensuring that important information has been communicated before the practices reopen.
Supporting Patients While Providers Cover Labor and Delivery
After-hours triage also occupies a unique place between patients and their OB providers.
A physician may spend the day seeing patients in the office and then go directly to the hospital to cover labor and delivery, according to Parker. Meanwhile, patients continue to have questions overnight.
Some require immediate physician involvement. Others require knowledgeable nursing guidance and reassurance.
“At 2:00 in the morning, an understandably worried expectant parent may call because they lost their mucus plug, have a nosebleed, or want to know whether they can take Tylenol,” Parker said. “Those are completely valid questions, and patients deserve to have someone available to answer them. However, they do not always require waking an exhausted physician between deliveries.”
The nurse’s role is to recognize which concerns can be addressed through nursing guidance and which require escalation.
“We can be that knowledgeable, reassuring first point of contact while still recognizing the situations that truly require the provider’s immediate involvement,” Parker said.
A Nursing Career That Started at 35
Parker’s current role grew out of a career that did not begin with a traditional path into nursing.
Nursing was her second career. At 35, she chose to earn an associate degree in nursing because she wanted to enter the profession sooner.
“When I first became a nurse, I actually was not sure which specialty I wanted to pursue,” Parker said. “Labor and delivery interested me because it combined several areas of nursing that I was already drawn to, including emergency nursing and operating room nursing.”
She subsequently worked in fertility, pelvic floor therapy, prenatal education, the OR, case management and telephone triage. She also operated a prenatal education business for nearly 18 years.
In 2020, Parker began working as a telephone triage nurse. The experience eventually led her to create her own after-hours OB/GYN triage company, which now supports four practices. Capital Women’s Care, an organization representing approximately 80 OB/GYN offices, has also approved Nurse Core Triage as a triage service available to its practices.
“Starting Nurse Core Triage allowed me to take everything I had learned throughout my nursing career and use it to solve a problem I had seen firsthand for years,” Parker said.
What Nursing Taught Her About Building a Business
Nursing school prepared Parker to care for patients, not to run a company.
She had to learn the business side herself, including contracts, insurance, payroll, hiring, technology, taxes and other financial responsibilities. At the same time, she continued working her regular nursing job while building Nurse Core Triage and taking patient calls during evenings and overnight hours.
“In the beginning, when you are trying to grow a company, you wear almost every hat,” Parker said. “I was a nurse, business owner, salesperson, administrator, and everything in between.”
What did translate from nursing were the skills she had developed throughout her clinical career.
“Nursing taught me how to solve problems, prioritize, work under pressure, and keep going when things are difficult,” Parker said. “Those skills have probably helped me in entrepreneurship more than any formal business training could have.”
A Different Kind of Nursing Career
Parker’s path illustrates how specialty experience can lead nurses into roles that look very different from bedside care while still relying heavily on clinical knowledge.
Her career has included direct patient care, women’s health, education, remote triage and entrepreneurship. For Parker, that flexibility is one of nursing’s strengths.
Her advice for nurses is not to allow their age, starting point or initial nursing degree to determine how far their career can evolve.
“I would tell myself, ‘Don’t be afraid to jump in,’” Parker said. “Ask questions. Learn from experienced nurses. Volunteer for the experiences that intimidate you a little. That is how you grow.”
Parker now relies on the experience she accumulated across women’s health to help make decisions during the hours when patients cannot simply call their doctor’s office.
Sometimes those calls require reassurance. Sometimes they require a hospital evaluation. And sometimes, as Parker learned from the patient whose contractions led to questions about a persistent headache, the most important part of the call is discovering what the patient did not initially think to mention.
