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.

It says the medics got her to the chair and the friend took her to the bathroom.

Ah, yes it does. My mistake.

Do they call medics attendants in other countries? Maybe she's not from the US, and I'm getting hung up on that unnecessarily?

Ah, yes it does. My mistake.

Do they call medics attendants in other countries? Maybe she's not from the US, and I'm getting hung up on that unnecessarily?

My thought was that she wasn't sure if they were medics or emts and was just trying to be generally inclusive?

My thought was that she wasn't sure if they were medics or emts and was just trying to be generally inclusive?

I guess. But I would have thought a nurse could have come up with a better term than "attendants." It's like not knowing whether a nurse is an RN or LPN so you just call them "the doctor's helper" or "the waitress."

Maybe I am getting hung up on it unnecessarily. But, "ambulance attendant" connotes an unskilled position of servitude. You'd think a nurse would be attuned to that. I just don't understand why, I guess, the term "Medic" wasn't used. Maybe non-ER nurses don't understand the pro-hospital job titles?

hehe typo, but it stays. *Pre-hospital*

Specializes in Emergency & Trauma/Adult ICU.

For all of their job stresses, and there are many ... paramedics and EMTs get to focus on one patient at a time once they're in the truck. Patients perceive this, know that they've had their full attention, and so their perception of the ER nurse who is dealing with multiple patients of varying acuity at the same time suffers by comparison.

OP is from Canada, maybe that's just what they call them there.

Specializes in ER/ MEDICAL ICU / CCU/OB-GYN /CORRECTION.

Send it with a CC to the DON and hospital administrator.

Specializes in LTC.
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! SHTF.gif

And so that gives ER nurses a right to be rude. I don't have to be a ER nurse, or come to your triage to understand that the OP was treated as an inhumane being. Really ? You try going to your local ER, in pain, with anxiety and confusion and see how you feel if the nurse don't even look at you. What if this ER nurse treated your kids or your S.O. like this ? What would you say ? Put yourself in the OP shoes ?You back off.

OP send the letter and forward it to her boss as well.

Specializes in LTC.
She wanted my opinion, I gave it.

Based on the OPs letter, it would seem that the ER staff is there to "attend" to her. Prioritization be damned. I would never say "That's not my problem" to a patient, but I wouldn't have taken her to the bathroom either.

Like I said, there's no reason for rudeness, but damn. The ER isn't a place to get all of your needs met. It's a place to get you screened and stabilized.

I guarantee that if any of these "Oh my god, you ER nurses are so mean" posters were to go to an ER with an actual emergency where every nurse took all the time they needed with each and every patient and made sure all pillows were fluffed, and that every patient had every one of Maslow's need met, the waiting room would be so backed up, you'd probably never get seen.

No need to get defensive. What everyone is saying is that in the same amount of time it took the nurse to make that snide comment she could of offered some type of empathy. NO? Sometimes a nurse can just give a slight gentle touch, nod, smile, or simply eye contact to make someone feel a little more at ease. Obviously ABCs come first and maslow goes out the window but what is wrong with treating patients with a little more respect.

That goes for ALL NURSES !

Specializes in Oncology, Emergency.

After reading the post Fribblet has best summarized it from an ER nurse position. Apologies for any rudeness that you may have encountered; some people are just having a bad night or there is too much happening and priority determines all. . As an ER nurse i cover the Triage at times and honestly not my best assignment; i prefer to be in the back with patients. Triage is one area where a lot happens and you can never afford to snooze.

Reading your post it appears that you came in by ambulance and were directed to the waiting area; which means that your symptoms however genuine were not life threatening. When it comes to the ambulance, my first priority is to get there report and then after that we can socialize. I don't have any time to lose; the paramedics will take less than 3 minutes to give me report and after i will come to you; get Vitals, make my own observations and get your side of the story.....it would be stupid of me to talk to you about your symptoms and turn to the paramedics...loss of time and objectivity...if you are Hypertensive for instance; i need a baseline from the paramedics and then i can compare. And why do we have to turn you around...what is reported is what i see unless symptoms warrant further investigation....in your case it appears there was no need to turn you and do a full assessment at the moment......its called Triage and you are still dressed .The bathroom part is different thought...the nurse should have been courteous and explained that there was a wheel chair in the corner and since she couldn't leave the station and your friend would have to help.

And kindness + caring is what we have. We try not judge or criticize but we are all human and bad days happen and probably that was the nurses day.

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

Just a thought after reading all this: wait until you are REALLY ill, then come back and say 'Well the triage RN was really, REALLY nice, but....come to think of it, she WAS kind of slow in getting everything done'.

If ur really, seriously ill you would not give TWO HOOTS about what the RN is doing, as long as they are getting you quickly assessed, and your scans done, and the thousand other things she has to think about.

I was in a terrible car accident 5 years or so ago - was lucky to survive I was told - and if any nurses were rude to me, I could not have cared less. I WAS busting for the toilet and was given a commode to use and helped on & off till I went. I was very grateful for those efficient, if not so smiling nurses, that night. And they all looked tired and overworked to me - God bless ER/ED nurses!

Sometimes when u don't feel well, u can also imagine people don't say things how you would like, or they may say something the wrong way. But when u think ur seriously injured - and u start thinking about death - you could not care less.

If this triage nurse was efficient, be grateful I say and glad ur OK. Did the OP get good care in the end and r u OK?

Just my own personal story for some thought. I'd rather have an efficient if rude nurse, than one who hovered over me and wasn't actually DOING her job speedily & efficiently.

Specializes in Gen Surg, Peds, family med, geriatrics.
I'm going to get blasted for this...............

To the OP: Why didn't you voice your outrage at the time of the offense? You were in a unique position as a nurse and as a patient to reprimand those slobs who "cared" for you.

You are absolutely correct. Poor behavior has become rampant in every area of our lives. I wish you would have spoken up. You would have been your own advocate, and been an example to the rest of the people waiting in the ER for their turn to be treated like poop.

Naw, you're not going to get blasted. :) I have been asked that question a few times. To be honest, that was the last thing on my mind. At the time I was experiencing right sided numbness, weakness, dizziness and muscle spasms. I was terrified...the nurse in me coming up with all sorts of reasons including stroke, tumor, etc, etc, etc.

But that's the whole point of it....I was in absolute crisis. Had it not been for my friend being there and for those wonderful ambulance attendants, I would have been in hysterics. My friend bit her tongue as well...not because she was afraid to say something...she's not that kind of person....but because she was afraid of retribution and that I would be the one to take the heat.

Maybe I should have said something...but at that point in time I was in no position to do so. But I am now.

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.
Naw, you're not going to get blasted. :) I have been asked that question a few times. To be honest, that was the last thing on my mind. At the time I was experiencing right sided numbness, weakness, dizziness and muscle spasms. I was terrified...the nurse in me coming up with all sorts of reasons including stroke, tumor, etc, etc, etc.

But that's the whole point of it....I was in absolute crisis. Had it not been for my friend being there and for those wonderful ambulance attendants, I would have been in hysterics. My friend bit her tongue as well...not because she was afraid to say something...she's not that kind of person....but because she was afraid of retribution and that I would be the one to take the heat.

Maybe I should have said something...but at that point in time I was in no position to do so. But I am now.

R u OK now though? Hope it was nothing serious and yes u should follow up ur concerns.

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