Nursing, Pharm Careers at Poison-Control Centers

Specialists at poison–control centers have to think quickly, may get calls at all hours and routinely run across situations they never got training for in school.  “Your next phone call may be a child getting into something nontoxic, where all you have to do is reassure the mother,” says Anna Rouse Dulaney, PharmD, DABAT with the Carolinas Poison Center in Charlotte, N.C. “Or it could be an absolute train wreck — someone who took eight different things and is having seizures and heart rhythm abnormalities and you’ve got 30 seconds to tell a doctor what to do to keep the patient alive for the next couple of hours.”

New drugs regularly pour into the market and people always find ways to misuse substances – such as bath salts — so every day is a learning experience, Dulaney says.

Dulaney has worked in two poison–center roles. For six years, she answered the emergency lines as a registered pharmacist and a specialist in poison information, which is what they call employees – nurses or pharmacists — who answer poison emergency lines. After she received her doctorate in pharmacy, she got certified as a toxicologist.

In the first role, she didn’t dispense any drugs, but she used her knowledge of how they work in the body to determine what can happen when there’s an exposure.

Unfamiliar problems crop up daily “like what happens when people eat plants or get stung by critters or get bitten by snakes. Those are things that whether you’re a nurse or pharmacist you don’t get that background training,” Dulaney says.

Pharmacists and nurses teach each other

There are poison centers that use all nurses and there are poison centers that use all pharmacists, Dulaney says. When they work together, as they do at the Carolinas center, nurses can teach pharmacists more about what’s happening in the body after an exposure, and pharmacists can teach nurses more about drug reactions.

After she became certified as a toxicologist, she switched to training nurses and pharmacists who answer the phones. She now serves as a consultant for healthcare providers in her coverage area who need advice on assessing overdoses and exposures. “That’s fascinating for me, because I can impact care directly,” she says. She also teaches and lectures.

The field is evolving every day. When new drugs are approved there is little knowledge of what happens in an overdose. “You have to rely on what you know about drugs in the body and figure out what might happen and how to treat the patient,” she says.

Bedside experience helpful

Some poison–control centers hire new graduates. Dulaney’s center doesn’t because, “We feel like they need to have some bedside experience whether they’re nurses or pharmacists,” she says. “The difference between working in a poison center versus working at the bedside is you can’t see the patient. You can’t lay hands on them, you have fewer nonverbal cues. We like for people to have at least two years’ experience and the training is a minimum three to six months for us in toxicology, because you have to cover the snakes, the plants, the gases. Most people – nurses or pharmacists – will tell you it takes a full year before they feel comfortable in the job.”

You also have to have a sense of humor for the bizarre nature of some of the calls, Dulaney says. For instance, one call came in that a patient had overdosed and the family was so worried he would run off before the ambulance arrived that they duct-taped him to the front porch.

“Being empathetic and being able to tolerate the darker side of human nature (are needed skills) as well as the ability to shake it off and come back into work the next day,” she says.