Dealing with triage - page 2

My last triage shift two babies with colds came in, stable vitals, low grade fevers. Both to the waiting room, and one was a 3, one was a four triage level. Obviously the three went in first, but the four was fussy and crying in... Read More

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    Two different sets of parents, each with their own child. so I can't discuss one child with the other child's parents.
    hiddencatRN likes this.

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    And if it was one family, that would be a twofer and they go to the same room together at places I work. AND if it was the same family, it'd be really weird for one parent not to know about their other child's intubation and higher risk status and to be freaking out that their other child is getting treatment.
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    I have no advice. I think we have all been there done that. Sometimes I use the homcidal example: I say, "you know sometimes patients don't look sicker but what if they actually told me that they have plans to kill everyone in the waiting room. Then I would take them to the back looking all healthy even though that's not so healthy thinking, now is it?" And I saw its complicated, this triage thing. I know it's rough. It's just your turn. So sorry.
    R!XTER, canoehead, corky1272RN, and 1 other like this.
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    Quote from VICEDRN
    I say, "you know sometimes patients don't look sicker but what if they actually told me that they have plans to kill everyone in the waiting room."
    Don't think I won't use that one...LOL!
    VICEDRN and corky1272RN like this.
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    You can follow up with the assault example, " assailants often follow their victims to the hospital. What if patient was assaulted? What if assailant followed? You wouldn't to see that in the waiting room!" Use away. I didn't copyright this stuff.
    canoehead likes this.
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    Ideally, you perfect the art of being extremely nice AND extremely firm at the same time. I never give an estimate of a wait time, and I **confidently** explain that patients are seen not "in order" but by acuity.
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    Triage can be frustrating. I am often assigned the "door whore" position. The triage nurse is looked at as the guardian to the er doors. Patients think that if they can woo us or intimidate us, we will let them through the magic gateway. My routine answer "patients are seen in order of acuity." End of discussion. If they want to argue with me, I refer them to the charge nurse, (which in many instances is me) or the nurse supervisor. I am too busy to stand and argue with anyone about their stuffy nose. I should note, that after triage, before the patient leaves the triage room, I let them know that all the rooms in the back are filled and we will bring them back as soon as an appropriate room is cleaned. I also tell them to let me know if they feel worse and that I will check on them periodically. Most people are okay with this. Of course, if they are truly acute, I bring them back and make room for them. I'm pretty thick skinned, so I don't let it get to me. Really, they are not attacking you personally, they are attacking the position and would be doing the same to anyone in triage that day.
    Esme12 and Altra like this.
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    The "door whore" LOL!!

    I don't think many of our patients know what acuity means. Literally. I have to say we see the sickest first.

    Sadly, sometimes I agree with the complainers. Who wants to sit in a crowded waiting room with a cranky toddler for two hours, or maybe 4-5 hours? I have confidence that they will be fine (after 20-some years of nursing) but the parent is scared, thinking about leukemia or meningitis. My patients over 80 shouldn't be in a room with all the snot and germs, but they still get a "4" for that sore wrist.

    I'm complaining about the inevitable! I was hoping all you smart people would have tricks to make it better.
    Esme12, hiddencatRN, and Altra like this.
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    Our ED has a giant sign that basically states people are categorised and the people who are the sickest are seen first, also above the triage windows are signs saying 'you may think someone is jumping the queue but all patients are seen in order of need. '
    turnforthenurseRN and R!XTER like this.
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    I wish triage was truly based only the RN's clinical judgment and objective data ie vitals. Sadly way too many people know the tricks - faking syncope, faking seizures, fake retching or self-induced vomit, screaming and yelling to the point where all other patients are glaring at you and would gladly give up their spots in line since they too all have headaches now, peeing in the waiting room, pacing around and around, and full-on badgering you until you want to send them back just to maintain your sanity. What truly annoys me is the violent and beligerent patients, most with alcohol on board - who make a huge scene and get taken back sooner for safety when there is really nothing at all wrong with them. Now the guy writhing with the kidney stone has to wait longer.
    It took me a little while to trust my judgement, at first I would escalate almost anyone who complained, but then the volume we have been dealing with just got so out of control, that I learned I cannot just escalate everyone, and it must go only by acuity. I also find it really hard to stand my ground while to the rest of the patients/families waiting I look indifferent and uncaring, when they obviously have no idea what criteria I use to make my decisions.
    It sounds like you really did the right thing. I know from experience it is really hard to deal with the "waiting room gang-up" but stick to your guns and trust your judgement. You were given this position because you are able to handle it!
    canoehead likes this.

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