An open letter to the ER triage nurse

[laurasc]

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.

*************************************************************************************

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.

[canesdukegirl, BSN, RN]

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.

While I was reading through the posts, I saw that question come up and thought to myself, "She didn't address it because she had bigger fish to fry!"

Are you better? You must have been terrified. I am so sorry you had such a cold experience.

[martymoose, BSN, RN]

This situation makes me ask- why are ED's so pathetically staffed? No kidding that some people are crispy after working in those conditions.Why does one continue to work in those settings? My gosh, after reading the ED nurse experiences, my floor nursing isn't so bad after all ( said slightly sarcastically) I actually hate picking up patients after they have had negative ED experiences, cause now with the customer service crap out there we have to make up for things twice as much, and we get the blame. But why can't the public see it is from the horribly staffed ed ? If I was the op, I would send the letter to the ceo, then to the newspaper too! If management ran things right, some nurses who used to give a crap wouldn't be so fried.

[bsyrn, ASN, RN]

OP please do send an open letter to your newspaper as well as the head of the hospital . I agree, you were not treated properly or with respect. It is really sad that some of your fellow nurses are so quick to bash you instead of showing some empathy which I feel you deserve. It is a sad state of affairs...... BTW Yes, I have worked ER...and no I didn't treat patients like that. Go ahead comrades...FLAME AWAY!!!

[rumwynnieRN]

Send the letter.

It's true we don't know what her side of the story is, but by sending the letter, you open the door for discussion between (hopefully) said nurse and her boss. There are a variety of reasons for why she was rude, and this may have just been one of those really crappy days. In a naive (I'm still in school and not completely jaded yet) sense, this could potentially lead to a discussion in improvement. If I recall, you weren't asking that she get fired.

[laurasc]

Boy, I wish I had discovered this "Multi-quote earlier! :)

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.

Was there a surge happening @ that moment?

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!

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!

EmergencyNrse - You're right, I never worked in ER and I don't want to. But just because I don't work in ER doesn't mean I don't know what triage is all about. As for making sure that patients don't die while waiting...I live in Montreal...do you know how many times that has happened here already? As for what was happening at the time, all I can tell you was that the waiting room was half empty and that I was in and out of the hospital in 4 hours. Again, here in Montreal, 4 hours in an ER is almost unheard of....more often than not you wait at least 8 or more hours to be seen by the doc. Remember, I'm in Canada and our medical system is completely different from what you are familiar with.

Besides, I wasn't "armchair quarterbacking" her triaging skills....I was commenting on her basic nursing skills.

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

Actually, strictly speaking they are called Ambulance Technicians (Techniciens Ambulanciers in French). Here in Quebec there are no "Paramedics" as you know them. The ambulance techs can do basic assessments but are very limited in what medical treatment they can perform.

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.

Except she didn't assess me.

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?

None taken.

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?

Look what I wrote about our ambulance attendants above.

I wasn't expecting to be treated like a goddess....in fact, once I got past the triage nurse I was treated very well. And I wasn't expecting to be put on a bedpan or shuffled to the bathroom by the triage nurse. I know she has other things to attend to. And just because I have not worked in the ER doesn't mean I don't understand...or at the very least empathize with nurses working there. I think you missed the point of my letter...and maybe I should rewrite it to clarify it. In the grand scheme of things the treatment I got from that triage nurse was nothing compared to what others get. But isn't that just the point? I wrote this letter to the triage nurse, but it could have been any nurse. We've all seen abuse. I wrote the following:

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.

I thank the Lord that those nurses are the exception rather than the rule.

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

Yeah, I'm better but still not normal. I'm following-up with my doctor tomorrow. Thanks for asking.

[morte, LPN, LVN]

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.

*************************************************************************************

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.

obviously she was still on a stretcher, not in the waiting room, and the nano second it would have taken to look her in the eye, really.! telling her to walk to the BR, while she is still on the stretcher, with no assessment of her ability to do so? hmm was this the Triage nurses crude attempt at assessment? And she is right, no matter the conditions, rudeness is not nec. It seems clear to me she was asking for the use of a BR, NOT with the expectation the nurse would be assisting her.....remember this is a patient who came in with neuro sx, she may well NOT be able to walk to the BR! The paramedics comment is the icing on the cake, this triage nurse must have quite a reputation!

[Anna Flaxis, BSN, RN]

Except she didn't assess me.

Triage nurses don't do "assessments" in the traditional sense of the word. I was referring to when I am receiving a medic unit in the back.

Once you got back into a room, the nurse assessed you, no? And your experience was good once you got back? You were in and out in 4 hours, when the average wait just to be seen is 8? Could it be that the "rude" triage nurse was so efficient in her role that this contributed to your getting seen and dispositioned so quickly? And none of this is included in your letter?

Sounds like you had a great experience in that ED other than a rude remark from one staff member. I think if you're going to send a letter, you ought to include that information, too.

[Altra, BSN, RN]

A couple of key points, from an ER point of view:

1. If the OP was in & out in under 4 hours -- that's essentially a fast-track/urgent care course of treatment. I am not looking for the OP to discuss what her diagnosis was (that's her business and her business only) but I strongly suspect a complex migraine, which was resolved pretty promptly with IV fluid and that ER's migraine treatment of choice (Toradol, Compazine, caffeine, etc.) I am thankful to hear that the OP did not in fact suffer a CVA, aneurysm, etc. Thank goodness!

2. If you call EMS for an ambulance but are directed to the waiting room -- that means that despite the fact that you called 911 -- the EMS crew who has assessed has given the heads up to the ER that you are "triageable" meaning your chief complaint does not necessarily warrant an immediate room assignment.

I sometimes think that some patients/families get so wrapped up in their stress levels that they lose sight of the fact that these are good things -- meaning, a medical professional has determined that whatever is happening to you is not so bad after all. I have been known to tell patients/families some version of this truism -- "you do not want to be the one we're rushing back immediately". If you are rushed back, and lots of people are paying attention to you at once, that does not constitute "good service" -- it probably means that we're worried you're going to die within the next 30 minutes. Not a situation you want to be in.

3. Again, I'm not looking for the OP to discuss her course of treatment in detail but there are a couple of details that are lacking that do become important if some on this thread are going to attempt to dissect the going-to-the-bathroom scenario. If OP was taken into the waiting room on the EMS stretcher, they would have gotten her off the stretcher and into a chair or wheelchair, because EMS needs to leave with their stretcher! I wonder if this is a case of "the triage nurse didn't even look at me" when in fact she did eyeball the patient as she (independently?) transferred herself to a chair or wheelchair while simultaneously filling out whatever ridiculously long triage documentation she is required to do. Come on fellow nurses -- every single time you encounter a patient you simultaneously assess their mental status, breathing, color, respirations, emotional state -- while seeming to the uneducated eye to just be having a quick friendly conversation.

[Altra, BSN, RN]

This situation makes me ask- why are ED's so pathetically staffed? No kidding that some people are crispy after working in those conditions.Why does one continue to work in those settings? My gosh, after reading the ED nurse experiences, my floor nursing isn't so bad after all ( said slightly sarcastically) I actually hate picking up patients after they have had negative ED experiences, cause now with the customer service crap out there we have to make up for things twice as much, and we get the blame. But why can't the public see it is from the horribly staffed ed ? If I was the op, I would send the letter to the ceo, then to the newspaper too! If management ran things right, some nurses who used to give a crap wouldn't be so fried.

My ER is staffed as best as it possibly can be, that's not the problem. We are stafffed at peak times to account for all the hallway spaces and a float nurse without an assignment to transport, put out fires, provide a little TLC, etc.

The problem is that the volume of patients still considerably exceeds the available space in which to treat them. A big part of this is delays in getting admitted patients out of the ER and on to their assigned inpatient units ... but that's a whole other thread, no?

[morte, LPN, LVN]

A couple of key points, from an ER point of view:

1. If the OP was in & out in under 4 hours -- that's essentially a fast-track/urgent care course of treatment. I am not looking for the OP to discuss what her diagnosis was (that's her business and her business only) but I strongly suspect a complex migraine, which was resolved pretty promptly with IV fluid and that ER's migraine treatment of choice (Toradol, Compazine, caffeine, etc.) I am thankful to hear that the OP did not in fact suffer a CVA, aneurysm, etc. Thank goodness!

2. If you call EMS for an ambulance but are directed to the waiting room -- that means that despite the fact that you called 911 -- the EMS crew who has assessed has given the heads up to the ER that you are "triageable" meaning your chief complaint does not necessarily warrant an immediate room assignment.

I sometimes think that some patients/families get so wrapped up in their stress levels that they lose sight of the fact that these are good things -- meaning, a medical professional has determined that whatever is happening to you is not so bad after all. I have been known to tell patients/families some version of this truism -- "you do not want to be the one we're rushing back immediately". If you are rushed back, and lots of people are paying attention to you at once, that does not constitute "good service" -- it probably means that we're worried you're going to die within the next 30 minutes. Not a situation you want to be in.

3. Again, I'm not looking for the OP to discuss her course of treatment in detail but there are a couple of details that are lacking that do become important if some on this thread are going to attempt to dissect the going-to-the-bathroom scenario. If OP was taken into the waiting room on the EMS stretcher, they would have gotten her off the stretcher and into a chair or wheelchair, because EMS needs to leave with their stretcher! I wonder if this is a case of "the triage nurse didn't even look at me" when in fact she did eyeball the patient as she (independently?) transferred herself to a chair or wheelchair while simultaneously filling out whatever ridiculously long triage documentation she is required to do. Come on fellow nurses -- every single time you encounter a patient you simultaneously assess their mental status, breathing, color, respirations, emotional state -- while seeming to the uneducated eye to just be having a quick friendly conversation.

Where are you getting your info, I just reread the op and see no mention of being in the waiting room or a time frame of treatment.

[Altra, BSN, RN]

Where are you getting your info, I just reread the op and see no mention of being in the waiting room or a time frame of treatment.

I'm getting it from the OP's update in post #52:

...

As for what was happening at the time, all I can tell you was that the waiting room was half empty and that I was in and out of the hospital in 4 hours. Again, here in Montreal, 4 hours in an ER is almost unheard of....more often than not you wait at least 8 or more hours to be seen by the doc.

...

[morte, LPN, LVN]

I'm getting it from the OP's update in post #52:

ah, but, she wasn't in/hadn't been in the waiting room at the time of the triage.......and the fact they werent busy makes the behavior of the triage nurse all the less forgivable!