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 the waiting room, resulting in more snot, and general misery. Dad came to triage angry that the less sick baby got to go in first, and I told him the sickest are seen first. He felt his child was obviously sicker, and got some support from the waiting room crowd.
His child was more vocal, and better hydrated, and not as sick per triage rules. The other baby had an RSV and intubation history, but I can't tell them that because it's confidential. But the entire waiting room turned hostile that night, because it was obvious to them who was sicker. No matter what I said or how, in their eyes I was wrong, and could potentially be called rude. I offered all the nursing interventions I could, like juice, or diapers, but they wanted to see the DOCTOR, not me.
Some variation of this happens every night. Twice I've had patients pee in the triage chair and all over the floor, and say they couldn't possibly go to the waiting room, triaged a 4 before they peed. There are lots of tricks to get ahead of the line, and it gets wearisome.
Vomiting is another one, a retching patient looks pitiful and usually goes back, but they've jumped several hours of waiting. A young woman was overserved the night before and came into the ER with the dry heaves with her Mom. Mom didn't know why she was vomiting. Pt wasn't orthostatic, and she was clear about the cause, so I made her a 4. My life would have been much easier if I'd brought her right back, because with the chest pains and an MVA she was lying on the ER chairs for 4 hours, and had stopped retching, but looked darn pathetic. A volunteer firefighter, unrelated to the patient, helpfully told me how sick she was, and that she needed to see a doc. (Thanks a lot.)
So who else has this problem, and how do you avoid the triage nurse hatred syndrome? I've tried bringing out unused gerichairs to the waiting room, but I have to police that, so it has drawbacks. Also, next time people come in they ask for a recliner that may not be available, or they may not even be the sick one in the group. (roll eyes)
