Crowd Control

Specialties Emergency

Published

I have been having some issues with crowd control lately, especially in the triage area. I am having pts or family members of pts waiting to be seen interrupting me while I am with another pt who deserves my undivided attention. Sometimes they actually surround my cubicle and stare at me ot tap on the window. If I don't move fast enough for them, they bypass me and go to security and tell them that they or their family member is REALLY sick and REALLY needs to be seen NOW. SO then security brings them to me and interrupts my current triage and 9 times out of time, it is bullshit and the pt is in no distress. Abd then when you get the one pt who IS in distress and DOES need to be seen immediately, a riot breaks out because I am seeing this one before that one. Security is of NO help. Last night I was interrupted by a pt who had been there twice already b/c he had gotten kicked in the testicle. HE had had 2 ultrasounds which were normal but he was still in a lot of pain. Some woman who wasn't even a family member told me that she thought we misdiagnosed him and that we should check his appendix because the pain had moved to the lower left side of his abdomen. To ease her mind, I tried to explain to her where the appendix was located and that his pain was most likely related to the injury and that he would defintely be seen asap. She told me that I was confrontational with her and that she didn't like my tone of voice. I asked her to have a seat in the waiting room as she was being disruptive and she refused, pulled up a chair and continued to talk down to me. Meanwhile this poor guy is doubled over in pain. So then she of course goes off to complain about me and management kisses her ass, even though they were on my side. She is probably writing a letter to administration as we speak. My point is she was NOT a family member, she was completely wrong and she prevented me from getting the guy inside in a timely manner.I also had a clerk last night inform me that her sister, who was in NO distress was here. I had 4 pts in front of her, that were actually pretty sick. THe clerk kept calling me to tell me her sister hadn't been seen yet. Duh. SHe then bypassed me and took her sister inside who was d/c 2 hours later. THIS is what I am talking about. I don't know how to deal with the masses because no one seems to back me up. Any advice, before I go off and stick a pencil in my eye? I actually cried last night.:(

Whoa, I don't see any similarity between a celebrity leading the police on a chase after his ex-wife, who he was known to abuse, was found murdered, and an overwhlemed triage nurse who has a management with no back bone. But maybe that's just me. :confused:

I can actually see the media making the situation worse because they would probably show a pt, teary-eyed and complaining "I've been waiting for two hours with this sore throat I've had since noon, I could barely scarf down my biggie fries at lunch and now my nose is getting stuffed up. And just 15 minutes ago they took some guy with a little bit of chest pain in before me, when I was clearly the next in line."

Then there would be a commentary on how people are suffering in the waiting room, and the nursing staff isn't doing anything about it. The next days headline would probably be something like "Triage Nurse Reprimanded By Hospital Administration". :rolleyes:

Sorry Terra, it sounds like the only way things will change is if management backs you up. You can't effectively triage in that atmosphere. Hopefully it won't take something serious to enforce the triage policy.

Geez, guys I didn't say I cried in public. It was in the privacy of the dirty utility room. I DID talk to my head nurse the next day and she talked to security. Now all of the security guards hate me. We are an urban hospital and I think we should have cops but that will never happen. I talked to the head of security as well and she said she would take care of it. Well, last night I covered triage for an hour while the other nurse went to dinner and nothing had changed. My cubicle has no door or any way for me to lock people out and again I had a problem with crowd control. There must have been 6 people at my cubicle. I took care of it but I still had to put up with a bunch of bullshit about why did you call this one first, my daughter is really sick(she wasn't), etc. The point is, I talked to management , I talked to head of security and nothing has changed. Because we are customer service oriented. And also because I could probably beat up our security guards, that's how intimidating they are. Also, I cannot see the waiting room from my cubicle either, which sucks. I also spoke to mx about how security sees a pregnant belly and wheels them inside without seeing me. We had a 6 mos pregnant woman with an asthma attack. It had nothing to do with the baby. We ARE an emergency room. We DO treat asthma. I don't think the TV cameras would fly in our ER. I would love to write an editorial about it but it would have to be all in Spanish because most of our pts don't speak English!:(

Also...last week I was repeatedly threatened by a woman who accused me of being sarcastic. I had been at work for 5 minutes and was getting report and she overheard the report and said, " Why are you talking about my son?" I told her it was a new shift and I was just coming on and I needed a report of what was going on," And she I was sarcastic (:confused: :( and threatned to jump over the desk and " jack me up" I literally had no clue what she was talking about. So anyway, the entire time she was there she would threaten me each time I walked by. And I never made eye contact because I believed she WOULD " jack me up". So I told my charg nurse and she laughed at me. That's how mx backs you up here. It's all about the customer service. Even when the customer is clearly wrong.:o

Specializes in Nephrology, Cardiology, ER, ICU.

Terra - I'm really sorry you work in such a place. I work in a level one truama center (urban inner-city). We too have some rude folks. However, we have added a paramedic at triage to help the triage RN. We also have a hostess that takes the name of the patient upon arrival. Come work for us. While our place isn't perfect - management is very receptive to trying new things.

I work in a relatively small ED but we serve a large area. We get occasional threats from patients and family members, and it is absolutely not tolerated. The last pt to threaten a nurse was approached by several staff members while the charge nurse informed him that assaulting a healthcare worker is a felony offense, and threats are taken seriously. When security arrived they were told that the pt could stay for now, but if another threat was made he was to be escorted from hospital property. Security stayed at the room until the pt was d/c'd.

Terra, if it were me in your shoes, I'd be revamping my resume' and looking for a better place of employment.

TerraRN:

We're just looking out for you! Don't let them get to you! Also,

just a little critique, DON'T OFFER ANSWERS TO THEIR QUESTIONS,

DON'T EXPLAIN YOUR ACTIONS!!!!! You doing so opens a dialogue with them that you don't need to pursue. Try to only

look at the people you are actually triaging, and address your

questions to them when they are in your booth. Family is good

for the patient's support, and if you NEED info. that the patient

is not able to provide, but, otherwise, your duty is to the patient.

Your management team does not seem able/willing to provide

the support you need, and that's unfortunate. Maybe it is time

you thought about moving to another ER....

ScisRN,CEN:rolleyes:

Ditto to scis, also sounds like your triage area needs another RN-

I know it gets harry out there- sounds like you need a break from triage- I know I do once in a while!

Well, I have already made the decision that I will not stay in my current job for very long because I want to work in a level one trauma center. I am currently bound by contract though to my current hospital and have a year and a half to go. My shift is very short staffed. There is just no decorum on my shift. Last night the triage nurse decided to take a break without getting coverage and I look at the waiting room entrance and see about 10 angry people. Security said there was a very sick baby and that there was no nurse and the family was threatening to sue or something. So the charge nurse who was sitting around doing nothing told me to go and triage. ( I was taking care of 13 pts at the time) So turns out the baby WAS very sick..I tell mom to come inside but told everyone else to wait in the waiting room. There were about 10 family members there. Well later on I find all 10 family members at the bedside. Security had snuck them in. I was PISSED. I cleared them out and went off on security. AGAIN, who all blamed someone else. :( :(

Terra - you really should find a new place to work - no question - i have worked in multiple ed's and they were all "customer service driven" - however threats, intrudences on triage were never acceptable!!

i frequently get accused of being sarcastic - but of course - i am generally being rather sarcastic - when pt's complain i often say "and what time WAS your appt???"

then they threaten me, then they get kicked out - works well for me!:devil: :devil: :devil: :devil:

Wow. A year and a half? What kind of contract did you sign? Are they paying your nursing school bills? What's up?

Now you know why you were contracted for so long, apparently staffing that insititution is next to near impossible with the antics going on there!

My advice to you would be to lie low, do what you have to do in

order to provide safe, professional care to your patients, and try

to stay out of any altercations if possible. Sounds like the management there will hang nurses like you out to dry when

push comes to shove.

Also, take all the sick time and vacation time due to you in the

next year and a half. You'll need it to stay sane! Also, make

sure you start applying for new positions to line one up so you

can get out as soon as your contract expires. Best of Luck!

Scis RN CEN:rolleyes:

Always works for me when I am blessed to be in triage and I have a knucklehead who keeps coming up to triage and getting loud and obnoxious. After a few attempts of being pleasant, I get up and in a loud voice so that everyone else waiting can hear, I say "Sir/Ma'am the more times you keep coming up here and disrupting the flow, the longer EVeRYONE ELSE HERE has to wait!!!!

Then mob mentality kicks in and the other angry patients waiting turn their anger upon the knucklehead and they begin to argue. Then you can walk away and watch the show.

You may have to call the local P.D. when fists start flying......

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