Triage sucks!!! Any tips??

GoldenFire5 · May 5, 2007

I have firmly believed for a long time that there needs to be an ativan lick in the waiting area.

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Funny! :lol2:

neneRN, BSN, RN · May 6, 2007

We have dedicated triage nurses who ONLY work triage, they don't work in the back with pts and the rest of us never see the waiting room...works wonderfully!

RNinED · May 7, 2007

I agree with you Jennifer, I have worked in er alomg time I was fist a tech, then an LPN in fastrack now Im an RN and we rotate on doing triage in my er, each nurse at least gets one night a month if not 2. So yes get cranky and mean and nasty I do so do alot of the other senior clinical RN II's, fancy way of saying weve worked the pit for along time or ICU, and were generally the charge nurses. I work triage at least twice a month and you have to get mean and cranky to get anything through the morons thick skulls. Yes I also think everyone should get an Iv 14 or 16 gauge even a hangnail because you know they might need abx for infection, a lp, and a pelvic ( now in the case of males well make it a rectal or a foley), I also think that anyone complaining of abd. pain if we know there faking or seeking need an NG tube dropped.

WOW! :nono: I hope you are just venting. With the changes in health care laws/regulations, there is less tolerance for the above attitudes. I am not a bleeding heart and certainly do not like the state our healthcare is in but the fact remains many poor working adults do not have PMD or coverage. There is a whole generation that grew up without them and therefore the ED is their only acccess to care.

If we don't like the nonurgent in the ED then we must vote in elections that support changes. But please don't become less humane....the cost is too great.

I try to see the questions about waiting as if it were me asking it. I simply EMPATHISE and say "waiting is the worst thing, other than not breathing that is. I know you are here and will get you back as soon as possible. If any thing changes let the clerk know and I will check you out again." Then I order anything that I believe the doc will need and explain to the pt that this will help make the whole visit quicker for them. Pts thank me for helping them and understanding. All of this in less than 10 minutes per triage. Of course, sometimes I vent too.

sumas8 · May 8, 2007

It's amazing how the issues are so universal! We prefer aerial spraying of Valium..... I actually enjoy triage because, as someone else said, I only have to deal with the pt/spouse/child/friend/bar-stool mate they just met, etc. for a few minutes! and it is entertaining. I love the 'What is your emergency?' question, that so puts things in perspective. I am never rude, just calm and repetitive, and

never try to talk anyone out of 'walking out'- like that's a threat when you're knee deep in patients waiting....

Victoriakem · May 9, 2007

When it gets backed up in Triage, as usual occurence, I tell people they are # 22 or whatever on the list of people waiting to go back to be seen. I also tell people who really press me for a wait time, that people who are dying get first priority, no matter how long someone else has been waiting before them. "I'm sure you understand", & people seem to. Also, when it's crazy busy & I have been pressed into Triage "to take one for the team", because I can triage quickly, I call people with a certain 'don't mess with me" voice. I am always cordial but to the point when triaging. I tell them to save the whole gory story for the Dr, I just want what's going on now. That works for me, but after working only 4 hours in Triage last evening, I couldn't wait to get out of there, with up to 22+ people waiting for a treatment room.:heartbeat

duwah · May 25, 2007

Gotta say it helps to have a sense of humor. Also really liking people is a plus. I mean REALLY liking humans in general. Years ago I had a husband (yes...to all my friends...even I had a husband) who used to say that anybody could make pleasant folks like them. But it was magic when you could make unpleasant folks like you. Triage is the same way. While it may drive you wild to sort thru the junk to find the 'real reason" a person might sit in an ER when they could be any other place, it is a talent and need. Heads up. You are the front person for the whole hospital, and those persons depend upon you for their needs and safety.

bill4745, RN · May 25, 2007

A strong rum and coke when I get home really helps.

jojotoo, RN · May 26, 2007

the fact remains many poor working adults do not have PMD or coverage. There is a whole generation that grew up without them and therefore the ED is their only acccess to care.
If we don't like the nonurgent in the ED then we must vote in elections that support changes.

Vote to support change? Like more taxes??? How about if the nonworking poor get a job so that they can pay for their healthcare like the rest of us?

Why don't the working poor have insurance? Is it due to the fact that they dropped out of school, didn't acquire a skill or a trade to support themselves, or maybe are having children that they can't support without MY (taxes) help.

I'm tired of helping those who should be doing more to help THEMSELVES. I am for assisting those who need a tempoary hand due to a situational crisis. I'm not even against permanent aid to those that are truly disabled (physically or mentally), or those with catastrophic illnesses.

But I am against aiding those for whom being on the public dole has become a way of life. I am tired of triaging kids with fever who didn't get any Tylenol/ Motrin at home because the parents "didn't have any money" -though the same parents have fake nails, piercings, cigarettes, and better clothes than me. I am tired of seeing the same drunks and crackheads OVER and OVER again and changing out their stinking, lice ridden clothing and treating their scabies and hanging banana bags and then admitting them to either detox or psych for three days because they have an "addiction" and the feds/ state are willing to finance it. I am sick to death of the sense of entitlement that some people have, plus the fact that I and every other taxpayer has to pay for it, AND I have to take the ABUSE that I do in the ER.

:angryfire Whew!! Don't know where all that came from - must have been storing it up for a while. I didn't even work last night!!

Sorry, I guess I got slightly off topic there. :mad:

Back to the original question. This is what I try to do and the way I try to train the new nurses. Triage is supposed to be short and sweet. Just the facts. Like a previous poster said - save that long story for the doc, I just KNOW that he's going to want to hear it. I also separate the patient from his entourage. Only the patient gets to come in the triage room with me (unless he is a MINOR child, then ONE parent can come in; or if I absolutely have to have a family member for translation or to assist an elderly patient with mobility). This cuts way down on the amount of useless info that I am bombarded with and lets me pick out the kernels of info that will actually be beneficial for this visit. No cell phone use in triage. Just have to make/ complete that call? Do it in the wating room. If I'm paying attention to you, then you better be paying attention to me.

How long is the wait? Don't know, can't tell you. Where are you in that long pile of charts? Doesn't matter, things in the ER change by the minute. Approximate wait time? It's my understanding that according to JCAHO we are not to do anything that the patient can interpret as the staff not wanting to see them. (No matter how lame their complaint is.) So, you'll get one of two answers from me - "We're moving along pretty good right now" OR "You can see how busy it is, but we're moving as fast as we can".

I personally prefer to triage ( if I need to take an assignment instead of being charge). It limits the time I have to spend with morons. And we all know that a lot of morons come through triage. But being in triage also allows me to pull out those patients who are truly sick and get them to the back and start their care ASAP.

Irishgirl · May 26, 2007

in the er where i used to work they split the 12 hour triage shift in half. one nurse would do 7-1 in the morning, then s/he would go in the back and relieve someone on the floor. the nurse on the floor would then take the 1-7 triage shift. they'd relieve each other for lunch also. somewhere along the way, that stopped. i would spend 12 hours in triage and want to kick myself in the forehead by the end of the shift.

XMedik · May 26, 2007

Hi all, I'm new here. I worked in military medicine for about 23 years and a lot of it in the ER. My favorites were the 'emergency' sore throats at 3:00 am (who thought by sneeking in at an ungodly hour they wouldn't have to wait as long). We even tried to hang a sign that tried to estimate waiting times for non-emergencies. Didn't work...Just keep a stiff upper lip, maintain professionalism, and never let 'em see you sweat.

D

one_speed · May 26, 2007

Ah to be the hated triage nurse full time... like any other area in our department, spend too much time there and you can go crazy.

I love working triage. It just turns out that, like the charge RN position, most staff don't like the triage nurse because when you see them coming around the corner it means they are bringing more work. It has even gottten to the point of having to make two RNs paly rock - paper - scissors to see who would take the patient (this can spare the hard feelings of " The triage nurse is picking on me").

I know, it sounds childish, but the command presence that I usually have to portray doesn't always work when it is 5 am and everyone is giddy from lack of sleep.

Dealing with cranky patients? Be upfront and honest, try not to give vague inconsistent timings (I try to offer general answers like "we're pretty busy but things are moving smoothly" or " yeah, I know your friend told you to come to see us at 0400 to have your toe looked at, but we have only one Doctor on overnight; Yes sir, that is rediculous only having one doctor when it is so busy but that is the way things are... talk to you MP about it tomorrow. Please have a seat and an RN will call for you when the DOc is readyto see you"

Whatever you do, don't do what a coworker of mine did last week.

Crazy busy subacute care area, backed up triage... yada yada yada.. we all know the story.

I'm sitting at my desk and after the 4th stranger walks by and when questioned, asks to see the Doctor. I find out that the triage nurse ahd gottten fed up with ansering the HLITW question and cracked... she must have, because she was telling people to go into the back to have a look around to see how busy the department was...

I lost it... but strangely enough found I had little I could say to her face.

Personally I'd rather have control over the flow of patients and family members walking back into the ER. You get a good awareness of the overall flow of the department and if things are backing up in certain parts of the ER you can call the charge RN to look into it and make adjustments inpatient flow.

The situational awareness is crucial, and the arguements with the orifice of an MD over changing a triage score so he doesn't have to see the patient in our ambulatory care section is priceless. "Doc, you can dump the patient on the backed up sub-acute area, but I ain't changing my initial triage score".

Ian

arual56 · May 26, 2007

Let me start off by saying I really do like my new position in the ER. It was a good move for me,....but how the heck does anyone spend 8hrs in triage w/out ending up feeling cranky, mean and down right nasty!!! It wears me out!! I'd rather stay on the trauma side a work back to back truamas all night than spend 8-12hrs in triage!! You just can't make most of those people happy!!! Last shift I worked was very busy,.rainy night,.lots of MVC's,..this adult woman walks in c/o abd pain, her Mom is with her,..I do my triage thing,.pt actually states she "feels much better now,.maybe I should just go home and see my reg Dr in the morning",.Mom says no,.you need to see a Dr. and asks me "how long is the wait?" Of course I can't really answer that question,..over the next hour a woman walks in with a 3wk old "help, help,.my baby isn't breathing",. sure enough I have a blue baby I rush back,..then a man who almost severed his arm w/a table saw,blood everywhere,.passes out in the floor in front of the triage desk,.rush him back,..a 6wk old "not acting right" temp of 104,.rush her back,..all of this in front of everyone in the waiting room,..then the Mom of the abd pain comes up and asks "how much longer are we going to have to wait?",.again I explain that this isn't first come first serve,.this is an ER,.we see the life/limb threatening emergencies frst,.she looks at me and YELLS "You mean to tell me that since my daughter isn't as sick as some of these other people, we could sit out her all night?!!",...uuuhhhh yeah,.pretty much!! Why is that such a difficult concept for people to understand???
ARGGGGGGGGGGHHHHHHHH,....ok,.I'll stop now,..anyone have any tricks on handling the people?

There is nothing that you have said that is not TOO true. It is the only area of our ED that I truely hate. I don't know that it will help, but I have a pat answer I give most people like the one you have written about. "I'm sorry for your wait time, but this is not a first come, first serve facility. It is who ever is hurt the worst, sick the worst, or dying the fastest that will be seen first. I realize that this is hard to hear. The options I can give you are these: You can please sit down and relaxe and we will get with you as soon as possible; you can sign out against medical advice, which I don't encourage, but it is your decision; or I can call security and they will assure that you do sit down so as not to disturb the other patients." It is something I only use on unruly family members of patient's that can't seem to understand that they are at the hospital, not the Hilton.