Aim: To deepen the knowledge of difficulties in registered nurses telephone advice and identify possibilities to master these.

Background: Telephone advice increases the accessibility to health care and the streamlined work at primary health care centres. The goal of telephone advice nursing is to give a correct advice, adapted to the caller’s situation, in order to reach correct care level. However, nurses’ telephone advice includes risks for misjudgement and may risk the patient safety.

Methods: A systematic and manual literature study was used in CINAHL and Pubmed. A total of 38 studies were identified and 13 articles were screened in full text.

Findings: Nurses’ had difficulties in telephone advice in following areas: computerized decision aids, non-visual communication, third-part communication, limited resources, the nurses’ vulnerability, genus and ethnicity, and also ethical questions.

Conclusion: Nurses perceived difficulties in telephone advice. They should take part in the development of computerized decision support and receive continuous training in communication skills. Nurses’ telephone advice should be facilitated by the existence of an open climate at the workplace, to discuss and to reflect on difficulties, in order to reach patient safety.