An open letter to the ER triage nurse

NurseLoveJoy88, ASN, RN · May 25, 2011

Wow. I guess nurses eat their old and young.

FF-PHRN · May 25, 2011

The triage nurse was unjustly rude to you. Established. Appears she got the job done and you were successfully seen, treated and discharged. You now have follow up care scheduled and you are doing ok.

So, now it seems there are two choices.

1. Send the letter to her, her manager, the newspaper or whom ever you feel like. The nurse is likely to get fired, especially if you send it to everyone including local newspapers. Does that make anything any better? Was that comment really worthy of her losing her job? Not in my opinion.

2. Write it off as a nurse who was having a bad day. I seems pretty obvious that was the case. In all your years of nursing have you ever been rude unjustly. It has surely happened to me. Bad days happen. Give her the break and forget about it. It was just a bad five minutes in her day you happened to be a part of and all still ended just fine for you.

hiddencatRN, BSN, RN · May 25, 2011

I didn't say that it did.
ETA:
Let me explain further. Several people asked the OP why SHE didn't say anything at the time. The OP provides a legitimate reason: she was too overwhelmed (which also calls into question her observational and recall abilities at the time of the event, but that's something else altogether).
Regardless, the OP was surrounded, by her own opinion, two healthcare workers who stand as paragons. In summary: the OP should have said something if she was in a position to say something. She wasn't. She had at least three advocates who all failed. At least two of those advocates failed in their DUTY. Yet, the only problem the OP sees in the entire situation is that a nurse made a snippy remark.
Frankly, rudeness is unnecessary, but don't you think two medics who have only ONE patient, who witness a patient being so severely mistreated, and have a duty to protect their patient, should have stood up for that patient?
Failure to advocate is a much worse offense than rudeness.
But, hey, with all the problems with healthcare, and with all the problems in an ER, if rudeness is the only thing you can complain about, then I say "job well done!" to the ER.

See, this to me is passing the buck. The triage nurse was in the wrong but everyone else failed in greater ways so we should worry less about that triage nurse.

It sounds like the medics helped the OP to her wheelchair and the friend helped her to the bathroom. Perhaps they too felt like there was little to be gained by engaging the nurse. Perhaps the medics didn't feel comfortable confronting the nurse in front of the patient.

Or perhaps they felt defensive on behalf of the nurse, as a few here seem to be. Idk. It just really stands out blaringly to me that a more courteous word choice would have cost that nurse nothing but might have changed the OP 's experience considerably.

Fribblet · May 25, 2011

See, this to me is passing the buck. The triage nurse was in the wrong but everyone else failed in greater ways so we should worry less about that triage nurse.
It sounds like the medics helped the OP to her wheelchair and the friend helped her to the bathroom. Perhaps they too felt like there was little to be gained by engaging the nurse. Perhaps the medics didn't feel comfortable confronting the nurse in front of the patient.
Or perhaps they felt defensive on behalf of the nurse, as a few here seem to be. Idk. It just really stands out blaringly to me that a more courteous word choice would have cost that nurse nothing but might have changed the OP 's experience considerably.

How is it passing the buck?

If you don't feel comfortable confronting someone in the best interest of your patient, then maybe you (general, not specific) need to re-evaluate some things.

If the medics feel there was little to be gained by confronting the nurse about it, then what's the point of writing a letter and sending it to the damn newspaper as some have suggested. Based on some of the reactions here, you'd think the triage nurse amputated the wrong limb.

To me, changing someone's experience considerably might be making a wrong diagnoses, failing to treat, causing harm, etc.

It's the ER. It doesn't take much to NOT be rude, but for ****'s sake, get over yourself. A person thinks their dying, they're barely holding it together, they're in "crisis mode" and all they can think about is some off-hand, rude comment, that, given the OPs stated state of mind, is likely not remembered that accurately? And lets face it, if you're truly trying your best to "keep it together" urinating, and the overall rudeness or politeness of the nurse is the least of your concerns.

There's just a lot of little things about this that makes me call BS. And, being an ER nurse, I'm pretty good at sniffing out BS.

Cul2 · May 25, 2011

To the OP -- I not saying it was you duty to speak up. I'm saying that most patients won't speak up. Most standing by won't speak up, even spouses. Even other nurses or attendants won't often speak up. That's the problem. The idea of just forget and forgive, let it pass -- that's the reason why this kind of behavior keeps on happening. The nurse who was rude -- If no one challenges her, why shouldn't she think that it wasn't so bad, no one really minded; I had a bad day but it's okay. So, when the next bad day comes, why worry about how to react? I don't blame the patients when they're vulnerable, in pain, frightened -- even afraid that complaining might affect their care. But those overhearing must learn to intervene. I don't want to see the nurse crucified. But she needs to be confronted and must face the outcomes of such behavior. What are the outcomes? The lost of trust in the profession and in the system. It's an underground, under the radar condition. The patients won't tell you about it, but it will affect their relationship with nurses and the system in later encounters. These little, seemingly insignificant rude encounters add up and ultimately damage everyone in the profession.

Anna Flaxis, BSN, RN · May 25, 2011

Oh for frack's sake. I think we've beaten this horse to death. Yes, the triage nurse's comment was rude. But really, a letter to the media? Were I the OP, I'd be thanking my lucky stars that all I had was a complex migraine and not a stroke. Why waste so much energy on one bad experience?

Cul2 · May 25, 2011

"Oh for frack's sake. I think we've beaten this horse to death. Yes, the triage nurse's comment was rude. But really, a letter to the media? Were I the OP, I'd be thanking my lucky stars that all I had was a complex migraine and not a stroke. Why waste so much energy on one bad experience?"

Stargazer -- You make a good point. But you also make my point. You see, this is what happens when one doesn't face the issue head on. This is what happens when you don't take action at the moment, or at least least write a letter to the hospital administration. This is what happens when you don't do anything. It festers. It eats at you front the inside. And then the puss overflows. I agree. You face that nurse head on at the moment, or you write the letter. Then you move on, rather than going over and over and over and over it again and again and again and again. This is why it's important to get these issues out in the open right away and deal with them. It's good for the patient, and the long run it's good for the nurse. There's got to be an end.

steelydanfan · May 25, 2011

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.

It must be great to live in a place where one can CHOOSE the hospital EMS will take you to. In MY area (and most others from what i know of), you willl go to the closest hospital that can serve you.

And yes, she will talk to EMS first and not you. They are the responders on scene. You are angry at her because she did not give you props because you are a nurse, without any way of her knowing that fact in the first place!

I never understand these kinds of posts.

steelydanfan · May 25, 2011

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?

Fabulous, my dear; incredibly fabulous! Is there an award on this site for someone who makes a post that not only answers every point but does so with intelligence AND style?

No Stars In My Eyes · May 25, 2011

Yes, Stargazer, I agree; " the woulda-coulda-shoulda " has been thoroughly beat down to puree. The End.

manager123 · May 25, 2011

I am not sure the size of the hospital that you were taken to and that might have impacted the care /assessment received. Frankly, there are so many responses to this thread that I just didn't have time to read all of them and I apologize if the answer is in the thread somewhere.

I have a few comments:

1. Complex migraine or other symptoms that mimic a stroke need to be treated as stroke until proven otherwise. Had this been a stroke, you could have missed the window of opportunity for definitive treatment or transfer to another hospital capable of treating you.

2. Definitely send the letter. Send it to administration (find out the name of the CNO, if possible, and send it to her as well as the ED manager or director). They need to know. It might help the ED manager get more help in future budgets if that was part of the issue.

3. You might receive a hospital survey. Although it is "anonymous" don't attach the letter to that unless you want to see if anyone contacts you.. Doing so will indicate you wish to be contacted and it will share your MR number with the director/ manager/ or whoever gets the surveys.

4. If you feel up to it, and if no one has responded within a few weeks of sending the letter, send the letter to the Risk Management department and indicate you have had no response. At that point it will need to be treated as a grievance and you will get someone to call you very promptly or respond by mail. it is a federal requirement.

I wish you the best of health. In today's job market, yes, we can replace nurses who simply don't care anymore. Yes, we have to train and yes we lose valuable clinical skills but the compassion and desire to care are as important, if not more so at times, than clinical skills that can be taught.

mmbonds · May 25, 2011

Send it to the Administrators of the hospital and to the Board of Directors. Hospitals will be paid for performance in the next year. If the hospitals patient satisfaction scores are low, guess what? The hospital will not be reimbursed the full amount from medicare/medicaid. I am sure the commercial insurance companies will follow. Hospitals will not be able to afford to keep nurses who are rude and uncaring. Also, when you get your patient satisfaction survey, write down every detail and return the survey. I am appalled at the behavior of some nurses, just a few can ruin our reputation! I am truly sorry that you had this experience but maybe you voicing your experience will help things change at that hospital.

Good Luck!

Michelle, RN