An open letter to the ER triage nurse

Pixiesmom, BSN, RN · May 18, 2011

I would send it not only to the triage nurse but to her supervisor as well as HR.

SeeTheMoon · May 18, 2011

I'm not sure I would just send it to her. I believe if I were treated that way, her supervisor may just receive a copy as well.

EmergencyNrse · May 19, 2011

I'm not going to defend the triage nurse's action and behavior but a little note to all the acid comments from those that have never walked in those shoes...

Okay there is a sense of ER Burnout here but the thing that is omitted here is her point of view on this matter.(Her side of the story) Triage in a busy hospital is a beyond stressful and important position.

You are charged with handling the patients and families coming through the front door and (like in this situation) ambulances coming through the back door. You need to quickly assess those that just might die in the next few minutes to an hour. You are charges with reassessing patients already triaged ensuring people DO NOT DIE while waiting.

After JUST having arrived there you have no idea as to the ER status going on around you. I have had to sit on SEVERAL Level II's in my waiting room because there were no monitored beds available. Unstable angina, uncontrolled diabetics leaning toward DKA, fractures, lacerations, asthma kids, you name it... Controlled Chaos doesn't quite describe it.

Your assessment began with the EMS call and your acuity was downgraded during the radio report or when you arrived. Someone sent you to the lobby for triage or you would have wound up in a bed with a "Stroke Protocol" called hospital-wide.

Was there a surge happening @ that moment? Know what it means when "the Bus unloads" when you're already overwhelmed? Hey, it happens and we deal with it... we HAVE too. There is no dragging your feet holding beds or admissions. That's emergency medicine. When's the last time she was able to relieve her bladder? How often did she leave while you were in the lobby?

Just sayin'...

Sometimes it just okay that you arrived still breathing. "Armchair Quarterback" her actions??? You left still breathing. I say Job well-done!

We get a bad reputation discussing frequent fliers and drug-seekers at work and on this forum but that's not all the patients that give us problems...

I can't tell you how many hundreds/thousands of patients that come through the door completely and totally capable that become completely and totally DEPENDENT soon as they cross the threshold. As nurses it behooves you to allow the patient to act independently and DO for themselves. It is a dark path to bend over backwards and cater to their every need. You DID have an attendant WITH you to assist... you were able to relieve yourself with your friends assistance. Except for the flippant attitude where's the foul here?

Sheesssh!!!

Listen, I'm sorry you had what I'm sure was a scary episode in your life. I'm glad that you are okay but Back-Off a little bit here or come and join us in triage and pray no one dies in your care when the SHTF!

Anna Flaxis, BSN, RN · May 19, 2011

I am unfamiliar with the term "ambulance attendant". Were you not brought in by paramedics? This confuses me.

Okay, not excusing the triage nurse's behavior here in any way, shape or form, but I do want to point out that when I receive an ambulance, I need to take report from the paramedics so that A) I know what they saw when they arrived B) What happened during transport C) What meds you take, what allergies you have, and any pertinent medical history and D) So that they can get out of there and get on to their next call. While I am taking report, I may be scribbling notes on a piece of paper or ED flow sheet, not looking at you. After I have taken report from the paramedics, then I will assess you.

We don't triage ambulances; they come straight back to a room and their primary nurse takes report from the medics. But in the triage room, the triage nurse isn't spending too much time getting a detailed medical history or doing a detailed assessment. It's all about making a judgment call as to whether you are somebody that needs to go back right now, or if you can wait.

Again, I'm not excusing rudeness, it is unnecessary. It's just that sometimes, certain behaviors can take on the form of rudeness to the uninitiated. No offense, but could there have been a little of that going on?

carolmaccas66, BSN, RN · May 19, 2011

Nobody anywhere should be treated this way. But unless we as a profession recognise how much stress someone is under, nothing will ever change. U may have been her upteenth admission, maybe she was dead tired, maybe she wasn't feeling well herself. Maybe she was called in at short notice or earlier cos no-one else was there to take over.

It's up to us as a profession to MAKE management staff areas better by striking, or taking other drastic action to force their hand. If all the nurses and medical staff decided to strike for just even half a day, governments would have to do something re understaffing.

That doesn't negate your nurses' rudeness though.

I have said to others for years and years now that, nobody, just nobody cares about hospitals and the nursing profession unless they or a close family member/very close friend gets sick. Then they either see good care, or bad care.

And nothing will change if nurses keep putting up with this behaviour.

I would actually go SEE this person and tell her how I felt, I wouldn't write a letter. She would probably screw it up & put it in the nearest bin anyway. Ask her how she was feeling that day and how her rudeness made u feel. It will make u feel better as well, I think.

ADD: as nurses we just don't have time to hold someone's hand anymore, especially in a busy ER/ED. It's all about getting people thru & assessed as soon as possible.

d2k2ross · May 19, 2011

I have to admit, I am agahst at how many people are defending this triage "nurse". It is never, ever ok for a nurse to say to a patient, "That is not my problem". EVER. And just "getting out still breathing" is a "job well done"??? What hospital do you work at? Remind me never to take a family member there! To the OP, I firmly believe that you should not only send this letter to the nurse, but to HR as well. There is no excuse for this type of behavior. We go into this profession to help people, not treat them like dirt. If you can't handle the stressors that very obviously come with this line of work, find another!

bsnanat2 · May 19, 2011

i am so sorry that you had this experience. send the letter. the bottom line with the attitudes you described is unprofessionalism. blame it on burnout or whatever you like; there is no excuse for unprofessionalism. i think there is a real difference between burnout and unprofessionalism. stress and bad working conditions can cause burnout, but even tired, worn-out nurses behave professionally. that is what makes you a professional - conducting your work at the highest of standards when conditions are at their worst. there is a segment of the population that simply behaves badly. since they have no control over their working conditions or things at home, they take it out on patients. the college i just graduated from has two nursing programs that graduate students simultaneously and i have seen this same unprofessional behavior in several of the students from the other class. this is who they are. nursing programs no longer consider character and personal interviews in selecting students. it often comes down to who looks best on paper (grades). it is such a problem that a couple of the local hospitals have used the economy to severely limit the number of new graduate hires for the expressed purpose of not hiring anymore people of this type. one of the hr people told our class directly that 'you may have all a's and be jerk, and we don't want you.' i may be wrong, but this type of attitude seems to be more a personality flaw than a direct result of conditions. i've precepted with many nurses who were distressed with working conditions, but their patients never knew it. they were professionals. i've also seen some that were bitter and hateful no matter what. that's who they are. hospitals should use the current economy to weed out the bad apples. if you don't want to work, there are plenty of people who will. i went through a stretch of months were i hated my previous job, but i was still professional. i hope i always remember your experience because a nurse owes it to other nurses (not just patients) to always be a professional.

Fribblet · May 19, 2011

Let me know what you think.

As an ER RN who triages, I will do that.

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.

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.

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 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 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?

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.

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.

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?

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 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.

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.

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.

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.”

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.

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.

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.

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.

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

Anna Flaxis, BSN, RN · May 19, 2011

Again, saying "It's not my problem" was kinda rude, but the not making eye contact while listening to the paramedics' report....not rude.

Batman25 · May 19, 2011

The triage nurse can't legally leave the triage area to get you to the bathroom because it would put her and the facility at a liability should something happen to someone in the waiting room or coming in during that time. That doesn't however make it okay to say it's not their prob. That's rude, unprofessional, and flat out unacceptable. Asking you to wait a moment for another nurse or if you'd like your friend can assist you instead would be perfectly okay and appropriate.

I'd send the letter but delete the part about your friend. You didn't witness that and it's heresay. I would tend to ignore that based on that had I received the letter. Perhaps this nurse just needs a reminder into remaining a professional at all times. That doesn't mean being all smiles and rainbows but it does mean being respectful.

PrettyWingsFNP, BSN, MSN, RN, NP · May 19, 2011

ABSOLUTELY POSITIVELY send that letter to the nursing director of the hospital, the ED manager and the nurse (use her name and describing characteristics ie hair color, glasses, etc). Also, CC each individual on the bottom so they know it is going to everyone. SO sorry you were treated that way! SHAME ON THAT NURSE!

Besides the fact that you shouldn't treat a person like that, I would NEVER let a pt experiencing neuro changes walk to the BR without MY assistance. I probably would have requested that you use a bedpan for your safety and pulled the curtain for your privacy.

bsnanat2 · May 19, 2011

So, am I to believe, based on some of the posts here, that one can't be civil and expeditious? Again, be professional. If you're having that hard of a time with it, maybe you're not as good at it as you think. Looks like fribblet needs a new line of work.