Re: How to keep the faith in triage?
I usually enjoy Triage. A couple of my colleagues say that I'm temperamentally suited for it too (no dilly-dalying. Get to the point and fast...) A couple
others say that I'm still too "young and naieve"
Triage is not easy. Priorotizing is the key. One of my triage-preceptors
loved to play this exercise:
"You have two patients. Patient A is a 45 year old complaining of chest pain all day. Upon furthur examination, pt. is found to be mildly SoB and states that his arms "feel funny". Has a history of high cholesterol and is mildly overweight. Vital signs are borderline - moderately elevated BP and HR. Marked tachypnea.
Patient B is a 90 year old with dyspnea on exertion and c/o "I don't feel like mtself. Tired all the time". Wheezing upon auscultation. Has an extensive history including prior MIs (with stents and caths), frequent UTIs, an old stroke with mild residual and cancer. Vitals are borderline - a temp of 101 F, HR in the 100s but a stable BP.
Now if you had just one bed left in the ED, which patient would you assign the bed to and which patient would you send back to the waiting room?"
So on and so forth...
Her "Q & A" sessions were absolutely brutal (
never an easy answer!) - but she was also fair and impartial.
I
learned TONS from her (heck, I still am learning!)
In a perfect world, triage would be
redundant.
However, as we do not live in a 'perfect world of infinite resources', your role as "Triage nurse" is not to act as the "Primary nurse" for the patient, but to decide "given the circumstances, who will potentially benefit the most from the
limited resources available in the ED".
It is a concept that needs to be stressed at every opportunity.
How do I keep the faith?
1. Stay focused.
Stay objective.
Yes, it sounds "cold" and not very "compassionate" - but trust me, it'll help you keep your sanity in Triage. Losing objectivity while pursuing compassion will lead to disaster (this is true for most aspects of nursing but especially true for triage).
2. Once I've triaged someone (and unless I send them back to the waiting room again), that patient is "out of sight, out of mind".
3. I try to keep my charge nurse in the loop as best as I can. Having another set of eyes keep an eye on triaged patients helps (especially if they're sent back to the waiting room because all beds in the ED are occupied).
4. There would be cases at times when a nurse assigned to a certain pod suddenly has three open beds and three patients show up. You feel "guilty" about 'slamming your friend/colleague' with 3 new patients back-to-back.
But you
must not shirk from it!
And this is really where a good charge nurse differentiates themselves from the average/mediocre ones - because they'll pitch in (start a line on one patient and do an EKG on another while the primary nurse assigned goes around with primary assessment and paperwork/labs etc.) As a triage nurse in such instances, I usually tarry for a minute or so to help change the patient into a gown, hand them a specimen cup with a cleansing towel and instructions on how to give a clean, mid-stream urine catch (if indicated) and hook them up to the bedside monitor (if I have time).
Other than that, it often boils down to the individual personality and experience of each nurse. Some nurses struggle with triage, some nurses excel at it. The vast majority of us fall somewhere in the middle.
I must also say that the practice of 'rotating staff' through different spots helps - if nothing else, at least to give folks a break from doing the same 'routine' and getting into a rut. It also helps refresh memory and competency.
cheers,
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