An open letter to the ER triage nurse

Nurses Relations

Published

I wrote this letter to a Triage nurse. I don't know her name as she did not introduce herself to me. I haven't decided what I am going to do with it...but I figured I would post it here to start. It's an interesting experience being on the other side of the gurney for a change.

Let me know what you think.

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I write this letter to the ER triage nurse who was on duty May 11, 2011 at a local hospital.

On that day I was taken to the ER by ambulance. I had experienced sudden neurological symptoms, was having trouble standing and walking and was very frightened even though I was trying very hard to stay calm. Anyone who's been in that situation knows how awful it is and how your mind races thinking up the worst case scenarios. I had chosen your hospital because I had been there in the past and know it to be an excellent hospital.

When you called me in (the ambulance attendants had to take a number and wait to be called) you sat down in front of your computer and started to take the report from one of the ambulance attendants. You barely looked away from your computer screen, and from my perspective didn't make eye contact with the ambulance attendant. You did not look at me or acknowledge me.

When you were done, I asked you if it was possible for me to go to the bathroom. You waved past the triage room towards the waiting room and said, "There's a bathroom over there, you can walk there."

My friend, who had accompanied me, responded, "But she's having trouble walking."

You responded, "That's not my problem. I can't go to the bathroom for her. There are wheelchairs all over the place."

The ambulance attendants helped me into a wheelchair and my friend took me to the bathroom.

You didn't know this at the time, but I will tell you this now....I am a Registered Nurse and have been for 26 years. I know what it is to be overwhelmed, overworked, undervalued, underpaid and frustrated. I know what it is to be stressed and I know how it feels to burn out. I've been there, done that and have the t-shirt so to speak.

I truly understand that your job can be difficult at best, But let me ask you something....how is all that my fault?

What did I, as your patient, do to deserve to be treated so rudely? Do you think I wanted to be there strapped to that ambulance gurney? Do you think I timed having my bladder being so full it was painful right for that moment? How much would it have cost you to turn to me and actually look at me? A nursing assessment consists of at the very least looking at your patient and not just relying on the report of the ambulance attendants. How difficult would it have been to simply tell me that you would get me a wheelchair once you were done? (There was one right next to my gurney) How difficult would it have been to crack a little smile? I wasn't asking anything complicated, all I wanted was to pee.

Remember, I am one of you. I too have been on your side of the bed and I too have felt the sting of the profession we chose. So I think it is safe for me to say, with some authority borne from experience that there is never an excuse for a nurse to treat his or her patient the way you treated me.

I'm writing this to put a voice to this problem. I know I'm not the only patient who's had to go through this or worse. Sadly, this kind of behaviour has become rampant. I see examples of that everywhere. Our current health care system with all its problems has put our profession is in crisis. The lack of funding, lack of resources and lack of staffing means that nurses are shouldering a huge burden. I get that! But our patients are in crisis as well and we are the professionals who are caring for them. That's why we are nurses, to care for people. Caring means kindness, not rudeness.

My friend, who is not a nurse, was aghast. She later told me that while we were in the triage room she witnessed another nurse yelling at a very elderly woman and dragging her down the hall by the hand. My friend was going to say something but was told by the ambulance attendant not to say anything because the nurse would "make a spectacle of her."

That is a sad statement considering we are talking about a profession known for caring. Have some of us really forgotten who and what we are and why we are doing what we do? Maybe we should all spend some time on "the other side of the gurney" for a change.

I do have to add one thing however, the ambulance attendants were phenomenal. They were caring, gentle, patient and knowledgeable...literally everything a health care professional should be and more.

Specializes in Rodeo Nursing (Neuro).
SHE WAS IN TRIAGE!~

I would NEVER let a pt experiencing neuro changes walk to the BR either. And working on both sides of the ER door I am assuming since this pt was brought in by EMT's or Paramedics (which by the way is so demeaning to refer to them as "attendants".) with what the OP refers to is "neurological symptoms" the severity of the symptoms had to of been downgraded that this crew was advised to take the pt to triage and not back into the ED for IMMEDIATE evaluation.

I have no tolerance for ingnorance on either side. It is unacceptable from the pt AND the nurse. I work ED, I work trigage, I know what the "battle field" is like. And I also know, THERE ARE TWO SIDES TO EVERY STORY.

The people who brought the patient by ambulance were not, as the OP explained earlier, EMTs or Paramedics. The incident occurred in Montreal. According to the OP, the correct term is Ambulance Technicians (or the French equivalent), but I'm not sure we can assume "attendants" is offensive.

One of the patient's reported symptoms at the time of the incident was "trouble walking." One defense of the triage nurse was that assessing the patient's gait would be appropriate, but if the nurse's words were quoted accurately, it's hard to get from that to a gait assessment. Of course we have no proof that any of this occurred, but if we aren't going to take the OP at her word, why discuss it at all? There are, indeed, two sides to every story, but it isn't always true that both sides are valid. There seems to be an attitude coming through a number of posts that emergency nurses are too busy saving lives to stoop to basic nursing care. I don't fully believe this is exactly what's meant, but it's getting hard to read it differently, and the idea that anyone who hasn't done it can't understand it is just a tad bit pompous. I've seen my own ED busting at the seams, calling for all available help to clear beds and avoid diversion (diversion meaning to a less capable facility, since the nearest comparable facility is 70-some miles away). But I've also seen times of relative calm, and a whole lot of in-between.

So, again, where exactly is the side, what is it I can't possibly grasp about emergency triage, that justifies the nurse's conduct? What about the OP's post was ignorant? Did the OP omit to report that there were mass casualties en route from a plane crash? Or that a drunk in the waiting room wanted to be admitted for belly button lint? Is Montreal under attack? The OP states the ED was quiet. How do we know it wasn't? The triage nurse didn't say, "I'm sorry, I can't help you right now." The patient wasn't asking for a cup of tea or to have her hair brushed. And if every other single patient who came through the doors that night was a completely unreasonable jackass, how was that the OP's fault? How does that give the triage nurse the right to act like a jerk?

Specializes in ER.

I don't like the way the triage nurse spoke to this poster, but I would not have left triage to help her if there were other people waiting to be triaged. If I had observed her getting from the stretcher to the chair and knew she could walk I would encourage her to do it with her friend's assistance. If she couldn't or refused I would point out a wheelchair and ask a friend to bring it to her.

The ambulance crew assessed her as able to go straight to triage...but the poster states she couldn't walk and had stroke symptoms. There are a lot of inconsistencies. I don't think it's fair to decide that either party was completely out of line. Let's everyone move on with our lives.

I had a patient last week that peed in triage without telling me or her husband she needed to go. She said she was on fluid pills, and had to go a lot. What I DIDN'T say would send some people on this thread over the edge.

Specializes in Trauma Surgery, Nursing Management.

I can't believe this thread is still going...

The people who brought the patient by ambulance were not, as the OP explained earlier, EMTs or Paramedics. The incident occurred in Montreal. According to the OP, the correct term is Ambulance Technicians (or the French equivalent), but I'm not sure we can assume "attendants" is offensive.

One of the patient's reported symptoms at the time of the incident was "trouble walking." One defense of the triage nurse was that assessing the patient's gait would be appropriate, but if the nurse's words were quoted accurately, it's hard to get from that to a gait assessment. Of course we have no proof that any of this occurred, but if we aren't going to take the OP at her word, why discuss it at all? There are, indeed, two sides to every story, but it isn't always true that both sides are valid. There seems to be an attitude coming through a number of posts that emergency nurses are too busy saving lives to stoop to basic nursing care. I don't fully believe this is exactly what's meant, but it's getting hard to read it differently, and the idea that anyone who hasn't done it can't understand it is just a tad bit pompous. I've seen my own ED busting at the seams, calling for all available help to clear beds and avoid diversion (diversion meaning to a less capable facility, since the nearest comparable facility is 70-some miles away). But I've also seen times of relative calm, and a whole lot of in-between.

So, again, where exactly is the side, what is it I can't possibly grasp about emergency triage, that justifies the nurse's conduct? What about the OP's post was ignorant? Did the OP omit to report that there were mass casualties en route from a plane crash? Or that a drunk in the waiting room wanted to be admitted for belly button lint? Is Montreal under attack? The OP states the ED was quiet. How do we know it wasn't? The triage nurse didn't say, "I'm sorry, I can't help you right now." The patient wasn't asking for a cup of tea or to have her hair brushed. And if every other single patient who came through the doors that night was a completely unreasonable jackass, how was that the OP's fault? How does that give the triage nurse the right to act like a jerk?[/quote]

:yeah::yeah::yeah::yeah::up::up::up::up::):):):) My point exactly.

Specializes in ED, Informatics, Clinical Analyst.
As an ER RN who triages, I will do that.

This is triage. While there's no reason to be rude, there isn't time for formal introductions. We get report from the Paramedics/EMTs. They aren't your "attendants;" they are professionals with specialized training and knowledge. I'm guessing Emergency Medicine is not your specialty.

You do realize that there's only ONE nurse to care for the ENTIRE waiting room. If there are 40 people in the lobby 20 of which have yet to even have trained eyes laid on them, assisting you to the toilet when there are capable people with you is a disservice to them. The triage nurse HAS to be available. If someone dumps a stabbing victim, or drops of a heroine overdose who's gone into respiratory arrest (and this does happen), I can't be tied up "attending" to you in the bathroom. Now, if you go into cardiac arrest, start seizing or stop breathing, then you'll have my undivided attention. Until then, I'm in disaster mode, and when disaster strikes, your bladder does not make it to the top of the priority list. ABCs.

You understand what it's like to have 20-40 (50 on a bad day) acutely ill (some critical) patients that you and you alone responsible for? Triage is a very, very dangerous place for a nurse to be in. It's not hard to get into legal hot water.

We don't do head-to-toe assessments in triage. How hard would it have been for your friend to get the wheelchair? Were their legs broken? Why do you want the ONLY licensed individual managing a room full of patients, a room where people are constantly walking in, to hold your hand while you pee? You had "attendants" with you and a buddy. Why do you expect the nurse to abandon all the other people who are waiting to be seen?

I think it's pretty obvious you have never been in a busy ER as a triage nurse. In fact, I would think that as a nurse you would understand that you're not the only patient in the room. By taking you to the toilet (which you already had 3 people with you who could do that. I still don't understand why you wanted the nurse to take you.) the nurse is neglecting all the other patients who still haven't been triaged. It's about prioritization.

While I don't disagree with your overall point, I don't think you have much experience in the ER. ERs are dangerous places for nurses. Next to police officers, we're the most likely people to be assaulted at their jobs. You have NO idea what's walking through the doors. People bring guns and knives to ERs. People are psychotic in ERs. People don't come neatly packaged with a diagnosis tied around their neck. Triage is supposed to take 4 minutes per patient. We're not here to hold your hand and whisper sweet nothings in your ear. We're there to see if you're dying or if you might die soon. That's not say people have to be rude, but in an overcrowded ER where the ONLY nurse is trying to keep the sick as **** people who are waiting from dying, while trying to quickly assess the ones that keep coming through the door, and manage angry patients and family members, a request from someone who has a capable visitor with them to take them to the bathroom would make me pretty ******. I wouldn't be rude, but I sure as **** wouldn't be sunshine and smiles either. Based only on the information you've given us, it would seem that you were unable to see that there were other people around you, many, likely, who had more pressing needs.

Wow. I'm convinced. Maybe she was yelling because the LOL couldn't hear well? Nah. All LOLs can hear a whisper. And, "my friend said this guy said.." doesn't really hold much weight.

You're right. Next time you come through triage with what you think is an emergency, I'm sure you'll be comforted to know you had to wait two hours to be triaged because the nurse was helping someone to the bathroom despite that person having visitor with them, or that the nurse can't see you right away even though you're having crushing chest pain because she's busy giving out hugs and talking with patients about their fears and dreams.

That kind of stuff is great when the ER isn't busting at the seams. I love slow nights when I can give my patients the kind of attention they deserve, but as the weather gets nicer, the ER gets busier and busier. We're there to intervene for emergencies. If you want hand holding, hair stroking, and full service toileting, you'll need to go to a well-staffed M/S floor. Welcome to the ER. If you leave breathing, well, you're welcome.

OF COURSE THEY WERE. YOU WERE THE ONLY PATIENT THEY WERE RESPONSIBLE FOR. Seriously? Do you not even realize that?

I haven't made it through the whole thread but THANK YOU Fribblet! We are EMTs or Paramedics.

You know how some nurses get upset when people refer to anyone wearing scrubs who isn't a doctor as a nurse? Well EMTs and Paramedics (especially paramedics) aren't crazy about being called attendants or ambulance drivers.

Your description of what happened is exactly what happens to about 95% of patients who are brought to the ER by ambulance. The triage nurse doesn't speak with the patient when they come in by ambulance. Ever. What exactly did you want/expect the nurse to do?

I used to be a paramedic and I don't take offense to the term "ambulance attendants." Certainly, it isn't the best way to describe them, but it works. Here, you might be transported by paramedics, but sometimes, it might be an EMT-B and a firefighter…it just depends on who shows up.

I think a lot of nurses (myself included) do what we do for so long that it is just second nature to us. We often forget that the general public doesn't understand why things take to long or why patients have to wait for things like going to the bathroom. I think we forget that people honestly don't know how busy we can be and we sometimes overreact to simple requests that we simply can't meet. I know a nurse that lectured a patient for asking for a blanket during a code. It would have taken her less time to simply get the blanket, but in the heat of the moment, she just went off…when the code was over, she went back to the patient's room and informed her that she wasn't the only person in the hospital and that she needed to quit being so selfish. The nurse was out of line and the patient had no idea why asking for a blanket was such an issue at that moment. I think if the patient knew and understood what was going on, she would have waited to ask for the blanket.

I also know that when people are scared and sick, they tend to overreact to things. I once wept like a baby because a restaurant forgot to put some of my food in the bag. I wasn't able to eat for several days and when I could finally eat, I didn't get what I wanted. I'm not saying the OP overreacted, but everything that was going through her mind at the time, might have made the nurse's comments seem worse than they normally would.

Specializes in ED, Informatics, Clinical Analyst.

I would rather my triage nurse be a complete and total b*tch who got me where I needed to be than a sappy idiot who was busy babying me rather than figuring out what was wrong. The nurse was rude but apparently she also did a stellar job triaging you because you got out of the hospital in record time and she was correct about whether or not you were having a CVA.

Get over it. Sticks and stones people. Am I saying it's okay to be rude? No but it happens and when it does I give people the benefit of the doubt. Why? because I would like for them to do the same if it were me having a bad day as opposed to writing letters that are likely to get me reprimanded or even fired to everyone and their mother.

Deleting my post as it doesn't take more then one person to show a misunderstanding in regional terms for different professionals.

I haven't made it through the whole thread but THANK YOU Fribblet! We are EMTs or Paramedics.

You know how some nurses get upset when people refer to anyone wearing scrubs who isn't a doctor as a nurse? Well EMTs and Paramedics (especially paramedics) aren't crazy about being called attendants or ambulance drivers.

Your description of what happened is exactly what happens to about 95% of patients who are brought to the ER by ambulance. The triage nurse doesn't speak with the patient when they come in by ambulance. Ever. What exactly did you want/expect the nurse to do?

You're more than welcome. I have nothing but love and respect for our front line partners. :)

However, it was explained later on that this is a regional thing and not a slight on EMTs/paramedics as we know them in the US.

I would rather my triage nurse be a complete and total b*tch who got me where I needed to be than a sappy idiot who was busy babying me rather than figuring out what was wrong. The nurse was rude but apparently she also did a stellar job triaging you because you got out of the hospital in record time and she was correct about whether or not you were having a CVA.

Get over it. Sticks and stones people. Am I saying it's okay to be rude? No but it happens and when it does I give people the benefit of the doubt. Why? because I would like for them to do the same if it were me having a bad day as opposed to writing letters that are likely to get me reprimanded or even fired to everyone and their mother.

Why would a nurse have to be either of those extremes? Would it be so hard to be somewhere in the middle (a vast area)? The nurse who is busy being a complete and total b*tch might be too busy b*tching to figure out what was wrong with me. I have been in emergency and non emergency medical situations and I have seen nurses do their job well without having to be rude to anybody. It is beginning to be suggested in this thread that a nice nurse is somehow less competent than a nurse that is rude and doesn't mind letting a patient know it.

I don't think the OP was expecting a sappy nurse. I think she wanted a little dignity and respect, heaven forbid!

I used to be a paramedic and I don't take offense to the term "ambulance attendants." Certainly, it isn't the best way to describe them, but it works. Here, you might be transported by paramedics, but sometimes, it might be an EMT-B and a firefighter...it just depends on who shows up.

I think a lot of nurses (myself included) do what we do for so long that it is just second nature to us. We often forget that the general public doesn't understand why things take to long or why patients have to wait for things like going to the bathroom. I think we forget that people honestly don't know how busy we can be and we sometimes overreact to simple requests that we simply can't meet. I know a nurse that lectured a patient for asking for a blanket during a code. It would have taken her less time to simply get the blanket, but in the heat of the moment, she just went off...when the code was over, she went back to the patient's room and informed her that she wasn't the only person in the hospital and that she needed to quit being so selfish. The nurse was out of line and the patient had no idea why asking for a blanket was such an issue at that moment. I think if the patient knew and understood what was going on, she would have waited to ask for the blanket.

I also know that when people are scared and sick, they tend to overreact to things. I once wept like a baby because a restaurant forgot to put some of my food in the bag. I wasn't able to eat for several days and when I could finally eat, I didn't get what I wanted. I'm not saying the OP overreacted, but everything that was going through her mind at the time, might have made the nurse's comments seem worse than they normally would.

I wouldn't have taken to kindly to being gone off on, but had that nurse done that to certain family members of mine and I was present I would NOT have let that nurse talk to my family member like that. We would have had it out right then and there and d*mn a letter. On the other hand, if my family member was being unreasonable and unfair to a nurse I would stop that too.

Specializes in ED, Informatics, Clinical Analyst.

I qualified my post by saying I hadn't gotten through the entire thread so I wasn't sure if it had been addressed at that point :)

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