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 Emergency & Trauma/Adult ICU.
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!

Not trying to pick on you morte, but if not in the waiting room how did she observe that the waiting room was half empty??

And ... this has been said a thousand times ... a half empty, or even empty, waiting room does not mean that there are not 50 kinds of hell going on in the back ... and vice versa.

Not trying to pick on you morte, but if not in the waiting room how did she observe that the waiting room was half empty??

And ... this has been said a thousand times ... a half empty, or even empty, waiting room does not mean that there are not 50 kinds of hell going on in the back ... and vice versa.

'cause i'm thinkin' they didna pahk the stretcher in da waitin' room!

and I was referring to your report of treatment time frame, NOT the state of the waiting room!

Specializes in ED, Flight.

There is no excuse for rude or negligent. None. Send that letter to the CNO of the hospital, with a request to be informed how they intend to address such a problem. I've done occasional triage. I haven't always been the most helpful or efficient; but I have always been careful to show some sympathy and respect. That is the very least we can do for every one who comes to triage. That nurse owes you an apology, and a promise to change for future patients.

BTW, if the letter goes public, don't be surprised if the EMS crew don't like it. They are not 'ambulance attendants', and haven't been since the 60s. EMS is a profession, like nursing. Even the volunteer services have to use trained crews. They are EMTs. Just a side note, there.

Specializes in Emergency & Trauma/Adult ICU.

morte, from the OP:

...

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.

...

She & the EMS crew were called into the triage area ... IN DA WAITIN' ROOM

And the report of OP's total treatment time is not "mine" -- it's the OP's report in post #52.

morte, from the OP:

She & the EMS crew were called into the triage area ... IN DA WAITIN' ROOM

And the report of OP's total treatment time is not "mine" -- it's the OP's report in post #52.

I have to admit, you have lost me. You must work in a strange ED if the triage is IN the waiting room!

and I was pointing out that you quoted the time frame for treatment, since it didn't come up when i "quoted" you.

and I was basing my comment on that, not the occupancy rate in da waitin' room!

Specializes in Emergency & Trauma/Adult ICU.
I have to admit, you have lost me. You must work in a strange ED if the triage is IN the waiting room!

and I was pointing out that you quoted the time frame for treatment, since it didn't come up when i "quoted" you.

and I was basing my comment on that, not the occupancy rate in da waitin' room!

Maybe we're somehow losing each other in terminology ...

In an emergency department there is what is usually loosely termed "the front" -- meaning the waiting room, triage, registration, etc.

And "the back" -- treatment rooms.

The vast majority of ambulances arrive via some type of ambulance bay which connects directly to "the back". However, as I explained in my previous post, ambulance crews will sometimes relay that the patient they're bringing in is "triageable" - meaning is not a chief complaint urgent/emergent enough to warrant an immediate room assignment, and they will bring that patient in through the "front" door so that the patient can proceed through the waiting room/triage/registration process just like ambulatory patients who arrive on their own. Sometimes they will come in and grab a wheelchair and transfer the patient from their stretcher to the w/c outside before coming in ... and sometimes they wheel the patient in on a stretcher (particularly in inclement weather) and transfer them once inside.

If triage does not take place immediately on EMS' arrival with the patient, EMS will remain with the patient until they can give report to the triage nurse -- just like any other patient handoff, professional to professional.

From the OP's description of being brought to the hospital in an ambulance but not proceeding directly to a treatment room, but waiting with the EMS crew until called by number into triage, etc. ... this is what I am envisioning.

Specializes in CVICU,ED,ICU,Nursing Supervisor.

My first question after reading this post by the OP was why isn't this in the ER section instead of the general nursing?

I agree that the triage nurse was rude to the OP but other than that what was her horrible, shameful offense? she didn't smile enough, smile not bright enough? did the OP expect the triage nurse to carry her physically to the bathroom? I am probably going to get killed by saying this but if she was in and out in 4 hours...well she wasn't exactly dying...

I have worked in ERs for many years and done triage on many busy nights and let me tell you it is a stressful and one of the most highly skilled jobs in the ER dept. As many of you have said, you have to assess that patient in a few short minutes and decide if they will die if you don't put them in a room or they are able to wait in the lobby.

I understand that the OP felt as though the triage nurse was rude, okay so maybe she was. but...she triaged you appropriately and that is the bottom line.

Specializes in LTC.

I think a nice thank you letter to the ambulance company might be in order :)

Specializes in Gen Surg, Peds, family med, geriatrics.
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.

Would you believe I was not assessed by a nurse at all? After I went to the bathroom I was told to wait in the waiting room in a wheelchair. After about 1/2 hour I was sent to an exam room. I waited there for quite a while and a doctor came in and examined me. He put me back in the waiting room and a while later I was send for a CT. Then back to the waiting room where I waited to be called to another room and was seen by the neurologist then sent home.

The only time I saw another nurse was after I told the neuro that I'm a nurse and can monitor my own BP (it was understandably elevated) and he mentioned it to a nurse in the ER. He (the nurse) stuck his head in and said told me to make sure I keep an eye on my BP and follow-up with the neuro in a few weeks. In fact, the last time my BP was taken was when I was lying in the ambulance gurney. The neuro tried to take my BP by the cuff there was too big and he ended up not bothering.

How did you get to the exam room?

Specializes in Emergency & Trauma/Adult ICU.
Would you believe I was not assessed by a nurse at all? After I went to the bathroom I was told to wait in the waiting room in a wheelchair. After about 1/2 hour I was sent to an exam room. I waited there for quite a while and a doctor came in and examined me. He put me back in the waiting room and a while later I was send for a CT. Then back to the waiting room where I waited to be called to another room and was seen by the neurologist then sent home.

This more or less confirms my interpretation of the fast-track nature of your visit, OP.

Complex migraine symptoms -- head CT & neuro consult just to make sure and demonstrate that the full range of differential diagnoses has been evaluated -- treatment of s/s -- and pretty quick discharge home.

Glad to hear it wasn't something more serious!

An ER nursing assessment isn't necessarily a head-to-toe assessment in the same manner in which it is for an inpatient.

I may well not see my fast-track patient more than once in a 4-hour course of treatment (though I probably eye-ball them 20 times while walking back & forth past their room.

Specializes in Gen Surg, Peds, family med, geriatrics.
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!

Very good! That's what they suspected. Problem is I'm not completely better and although the sx have improved they are still there.

Oh...and I got no meds...not even an IV.

And I'll be the first to admit that is part of why I am upset. All I could think of while I was waiting to be triaged was that I could be having a CVA and time is ticking away.

Besides, as I said earlier in this thread, the point of the letter is not to critique her assessment skills...regardless of what I think of them. But it's to bring to light an ever increasing problem....the fact that it seems that some nurses are forgetting why they are nurses. Their lack of caring and professionalism is appalling. That's what it's about.

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