Ancillary Staff with Tunnel Vision

[applesxoranges, BSN, RN]

I hate it when ancillary staff tries to take control of the situation. I know the person is having chest pain. Hence why I ordered labs, ekg, and xray. Do your job and do what was ordered. No the person is not going back right away due to no beds. I have my reasons why I do things because I talk to people and I get the picture. Guess what? Patient discharged hours later. Freaking out initially because it's chest pain and getting tunnel vision makes **** worse. Such as if we rushed her right back to the bed that was being cleaned we would have nowhere to put the 3 year old who couldn't breathe that had eaten candy without parents inspecting it that came in ten minutes later.

We had a situation the other day that was once again multiple complaints. The guy was sick. However, he was not someone that should go straight back. Another high blood pressure that we monitored in a bed for a bit because of no deficits and it wasn't as high as he said it was. However, the person that day listened and let me assess the patient to see how sick he/she was and we managed it.

Slow department? Hell, I'll do a straight back. Whatever. No beds? We have to prioritize. The reason why she didn't get the bed that opened up twenty minutes later? A higher priority came in.

When something is going down, I'll get a bed. When ancillary staff that is not an RN tries to take control of the situation over me? It can cause major issues. Frustrating! Being in school and a nursing assistant =/= triage RN.

[canoehead, BSN, RN]

You have the training and the authority, so you make the decisions. I feel your pain. If we have one bed and three patients that swear they must lie down, I draw labs and whoever is sickest gets the bed. During calmer moments I've explained my strategy to the secretaries I work with, and the LPNs. If you can't pull beds out of thin air, you have to find a fair way to pick out the sickest person. I've also sent people out for ten minutes to see if the excruciating pain gets better when they aren't right in front of me. theres a method to the madness.

It's important that other staff bring up their concerns in private, so you can have the time to explain. If someone walks in from the parking lot, then "passes out" directly in front of the triage desk, and they have normal vital signs in spite of their life threatening episode, I dont generally make them a 2

[Anna Flaxis, BSN, RN]

Yes, this drives me nuts, too. When beds are at a premium, an organized, strategic approach to patient flow is necessary. One person should be in charge of this. Nobody should be independently making these calls without checking in with that one person. This needs to be addressed- first, try speaking with the guilty parties first and if you don't see a change, then go up the chain of command. Good luck!