[RNintheER]

OK. Well we used to have one RN doing triage. Now we have two....sometimes 2 RN's sometimes an RN and an LVN. Technically, the RN at the window takes basic data, name, dob, pmd, allergies, and Chief Complaint. Then assigns a triage priority (1-5) puts a chart together and gives it to the nurse in the back. The nurse in the back is called a data collector to get past the sometimes LVN in that assignment. So the back nurse does vitals, asks PMH, surgical history, ht/wt/smoking history, etc. Then either rooms the patient or puts them in the lobby to wait for a room.
Our thing is that an RN and only an RN must remain at that window 24/7. We are busy and understaffed and sometimes we hardly get pee breaks!!!
I have seen other ER's where a registration clerk is at the window and you sign in with your complaint. No RN?
Does anyone know about this? It is frustrating me to no end! I believe they said its a DHS thing?
Our management is not so great though so who knows!
Thanks for any info!

[Vito Andolini]

Is the real problem that you are not getting to use the toilet when you need to or get your lunch break?

If so, you just need to let the boss know that you are going to have to shut down for a few minutes to urinate.

And isn't there someone scheduled to relieve you for lunch? If not, that needs to start happening. Advocate for yourself, help each other.

[RN-Cardiac]

You deserve your breaks,...but you must have the RN at triage at all times! A clerk is not qualified to triage.

[RNintheER]

The issue is that we are understaffed for break coverage as well as other hospitals having the no nurse at the triage window. Just wondering how other hospitals are doing it! Our director keeps saying how we are budgeted for 6 nurses each shift but we work with 9-10 and that is still not enough. I have to sign no lunch slips almost every other night!
Thanks for the replies!

[littleRNthatcould]

I've often wondered about the whole bathroom break/missed lunch thing, although I have done it way too many times to count myself. My thought is that you can't take care of anyone if you are not taking care of yourself first. How well can you assess someone and attend to their needs if you are distracted by being about to pee down your leg or feel like you are dying of starvation?

For all of my ER's faults, I can say that all the nurses pitch in and help cover all areas. Yes an RN needs to be in triage at all times, but there is the Charge nurse (if she doesn't have a group), other nurses whose patients are stable and can give you a few minutes. Even our staff educators and CNS have come out to give us breaks. It's not always possible, but when it is, it happens. Because upper management doesn't support us, we have learned to look out for each other and we're really kind of good at it.

Aside from the restroom/lunch break...sometimes you just need to get the h*ll out of the triage "box" to keep yourself sane

[mom2michael]

We never had an RN at our window at either place I worked. Patients walked in the registration clerk took their name, DOB and chief complaint and called us to come and triage. 99.9% of them had enough common sense to come get us NOW if there was a problem and skip the details.

These were both small rural ERs that saw about 50-75 patients per day. We staffed 2 RN's, 1 LPN (or ER Tech) and a Paramedic from 11-11. We also had a house supervisor to help us if necessary.

We just simply didn't have the staff to keep a licensed person at the front to greet patients and start triage immediately so we heavily relied on our unlicensed staff to alert us if there was a problem.

Not sure this is the best solution either though - you just shift one set of problems to another.

I no longer work ER but when I left they were seriously discussing how to keep an RN at the window 24/7 because of a "near miss" with an infant.

[Larry77]

RN should be the first to see the patient...if someone is very sick they will know in a flash...a clerk should not be judging how soon a patient is seen by a MD or RN.

We take the name, intitial c/o, and hx, then either send the patient to registration or to a triage room for a tech to take vitals and for us to finish with hx/meds/etc. If I'm really busy I'll get all the hx up front and be done with the chart and let the tech take the chart back or bring back to me if vitals abn. We do not room patients normally, unless it is slow--very rare in my dept.

[MassED]

Originally Posted by RNintheER

OK. Well we used to have one RN doing triage. Now we have two....sometimes 2 RN's sometimes an RN and an LVN. Technically, the RN at the window takes basic data, name, dob, pmd, allergies, and Chief Complaint. Then assigns a triage priority (1-5) puts a chart together and gives it to the nurse in the back. The nurse in the back is called a data collector to get past the sometimes LVN in that assignment. So the back nurse does vitals, asks PMH, surgical history, ht/wt/smoking history, etc. Then either rooms the patient or puts them in the lobby to wait for a room.
Our thing is that an RN and only an RN must remain at that window 24/7. We are busy and understaffed and sometimes we hardly get pee breaks!!!
I have seen other ER's where a registration clerk is at the window and you sign in with your complaint. No RN?
Does anyone know about this? It is frustrating me to no end! I believe they said its a DHS thing?
Our management is not so great though so who knows!
Thanks for any info!

where I work now - and where I worked one year ago in N.C. - they operate the triage process differently. JCAHO dicatates how it should be done - but they mess with it to suit their needs.

In N.C. it was like where you are - a medical person had to be the FIRST person to lay eyes on the person - either an RN (or likely an LPN) - since it was a "what's your name and c/c" - then registration did their thing and on to the triage nurse...

Here in Massachusetts, they have done away with that... up until 1 month ago it was a team leader RN that laid eyes on the patient, got a C/C - then the triage process... NOW it is this MS2 project (who knows what the heck that stands for) - but it was modeled after a level 1 trauma center in Maryland, I believe... so they think it's better and more effective. Here's how it goes: registration (I believe) sees the patient, gets the name... P.A. sees the patient and obtains a C/C and very little else (like PMH or meds, at least they don't CHART anything). So the patient is scooted to wherever they think is appropriate... peds ER, a staging area (ideally no one on drips here... like nitro), main ER, or a screening room (like the old urgent care). The nurse still does a triage when the patient is in the room. Which, can be done hours later, in my own experience. Once you are taking care of patients, you can't stop and obtain all of that info in a timely manner when you have 4 or 5 patients dropped on you, physicians seeing them... then implementing orders... and then to triage all of them. I miss the old way of doing things. It's not better for nurses, that's for sure. It's better aesthetically to the outsider looking in and seeing less congestion in the waiting room - though this hasn't helped that all that much. It's all about how it looks - I tell patients that it may help them get to me sooner, but it doesn't help me get things done quicker.

[MassED]

Originally Posted by MassED

where I work now - and where I worked one year ago in N.C. - they operate the triage process differently. JCAHO dicatates how it should be done - but they mess with it to suit their needs.

In N.C. it was like where you are - a medical person had to be the FIRST person to lay eyes on the person - either an RN (or likely an LPN) - since it was a "what's your name and c/c" - then registration did their thing and on to the triage nurse...

Here in Massachusetts, they have done away with that... up until 1 month ago it was a team leader RN that laid eyes on the patient, got a C/C - then the triage process... NOW it is this MS2 project (who knows what the heck that stands for) - but it was modeled after a level 1 trauma center in Maryland, I believe... so they think it's better and more effective. Here's how it goes: registration (I believe) sees the patient, gets the name... P.A. sees the patient and obtains a C/C and very little else (like PMH or meds, at least they don't CHART anything). So the patient is scooted to wherever they think is appropriate... peds ER, a staging area (ideally no one on drips here... like nitro), main ER, or a screening room (like the old urgent care). The nurse still does a triage when the patient is in the room. Which, can be done hours later, in my own experience. Once you are taking care of patients, you can't stop and obtain all of that info in a timely manner when you have 4 or 5 patients dropped on you, physicians seeing them... then implementing orders... and then to triage all of them. I miss the old way of doing things. It's not better for nurses, that's for sure. It's better aesthetically to the outsider looking in and seeing less congestion in the waiting room - though this hasn't helped that all that much. It's all about how it looks - I tell patients that it may help them get to me sooner, but it doesn't help me get things done quicker.

meant to write DICTATE, oops!

[FlyingScot]

We have a large desk in the ER lobby that is staffed by 2 CSAs (Customer Service Associates) they take the patient's name, DOB, SS# and chief complaint and enter it into the computer which places the patient on the computer tracking board which the triage nurse can see at all times. For CC they type in verbatim what the patient says to them which triggers an icon on the board. We can hover the cursor over the icon and their complaint becomes visible. The RNs then triage from the board. When they come back the RN then enters the official CC which triggers the type of triage questions that come up on the triage page and we alos sign them an acuity category. There is no posssible way the triage RN could keep up with the numbers of people flooding through the doors of our ER without the CSAs running interference for us. We sometimes have 70 people waiting to be triaged. I have never heard of a rule that the first person to speak to an ER patient has to be a licensed medical provider but I'm in Ohio so maybe things are different here. It just seems to me getting a name and DOB doesn't require much more than a highscool diploma. The CSAs are smart enough to recognize distress and with certain complaints (CP, SOB, Abd pain in pregancy) they are required to immediately notify the nurse. Not only that but our triage room is immediately behind the CSA desk so we can see the people as they walk in the door. Despite the fact that our ER is very busy the longest wait in the lobby I have ever seen is 4 hours which statistically isn't too bad.