Asked about citizenship during triage

Nurses General Nursing

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A friend went to the ER, and while being triaged he was asked if he was a US citizen ( this was in the USA of course). Is this customary? I never recalled being asked when I was a patient, nor do I recall asking when I was a nurse. Is this the new normal?

Wow. You completely DON'T understand. How could anyone read my post and think I am mocking the OP????

The "new normal" I referred to the racist, bigoted climate that has been given a new voice.

If you want to be upset about a post, why don't you comment on the bigoted remark made a poster telling OP to "loosen the hijab."

Ah, that got past you, didn't it?

Perhaps because you didn't actually say what you meant until just now.

And no, the other asinine comment did not get past me at all but was certainly more clear. You will have no luck with your attempt to paint me as someone who agrees with any such sentiment.

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Perhaps because you didn't actually say what you meant until just now.

And no, the other asinine comment did not get past me at all but was certainly more clear. You will have no luck with your attempt to paint me as someone who agrees with any such sentiment.

I am sorry that you don't understand the meaning of the phrase: said with tongue in cheek.

However, several other posters did understand. Including the OP, and that is all I care about.

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I am sorry that you don't understand the meaning of the phrase: said with tongue in cheek.

However, several other posters did understand. Including the OP, and that is all I care about.

Duly noted.

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Specializes in Pediatric Critical Care.
Wow. You completely DON'T understand. How could anyone read my post and think I am mocking the OP????

The "new normal" I referred to the racist, bigoted climate that has been given a new voice.

If you want to be upset about a post, why don't you comment on the bigoted remark made a poster telling OP to "loosen the hijab."

Ah, that got past you, didn't it?

....that escalated quickly. The other poster just asked for clarification, for goodness sake.

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Specializes in ICU, LTACH, Internal Medicine.

1). Yes, this question is common. Not mandatory, like ones about smoking and abuse, but nevertheless common.

2). The hospitals (as well as urgent care centers and certain rural facilities) do it most frequently because they are getting $$$ for serving certain populations. I am aware of at least two such programs involving hospitals and clinics located in areas with high seasonal %% of undocumented argicultural workers in my state. The state issued money help to provide treatments, vaccinations and preventive care for these workers who otherwise would live in communities for months with active Tb and deliver their babies in dangerous conditions. Of note, one of these programs was initiated by a group of home care nurses who accidentally got involved in care for these people and were appalled by unhuman conditions the workers and their children were living in.

It is my educated guess that the chances of that being connected somehow with QA are remote, because everyone (well.... supposed to, that is) gets the same level of treatment under EMTALA. Although getting statistics for insurance or data to involve social work trained in dealing with undocumented immigrants can be another possibility.

3). Everybody is completely free to call ICE and "report" whoever else. The "reporter" gets big hearty "thank you" and that will be that, unless the report is about some significant activity like organized human trafficking, abuse or drug ring. ICE is operating on Feds money, which means they are always short of pretty much everything. They may once in a while organize "stops" near schools, places of worship and community centers where undocumented immigrants are used to gather. But nobody will specifically hunt down certain John Doe if someone else suspected with no evidence to prove it that Mr. Doe has "no papers" and did nothing else wrong, especially accounting for the fact that the said Mr. Doe probably wouldn't have any reliable personal identification on admission in the ER and name an address of a random gas station in vicinity as his living address.

4) and the most important one: a patient seeking admission or receiving treatment in any medical facility in the USA has a right to refuse to answer every and any question he/she is asked. If you feel like you do not want to answer this question, like any other one, just say so. It is that simple. If you're still up to look further into the issue, send a certified letter to Patients' Relationship office.

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Katie, I understand what you're describing in paragraph two, but I still can't see why this would ever involve the triage nurse (or any nursing or medical staff). If this is information that the system has some legitimate need to know, they can obtain the information at some other point in the process after the MSE has been performed.

ETA: And the above holds true for my previous question whether this might be a misguided attempt at collecting data for "quality" purposes. There is just no need for nurses to be involved with this, unless it were to somehow come up in the course of genuinely trying to help a patient.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Posts containing a Terms of Service Violation regarding posting religiously/culturally offensive comments have been deleted and other posts have been edited to remove the reference to the offensive comment.

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Specializes in ICU, LTACH, Internal Medicine.
Katie, I understand what you're describing in paragraph two, but I still can't see why this would ever involve the triage nurse (or any nursing or medical staff). If this is information that the system has some legitimate need to know, they can obtain the information at some other point in the process after the MSE has been performed.

This is so because the i's must be dotted and squares must be marked. And, if a less educated person than that triage RN whould be charged with this kind of job, that person still be paid $$+ benefits, which would be more expensive than just one RN.

Yeah, we all know that if a Mr. Doe, 64, comes in with acute on 10-years old chronic back pain current 9/10 associated with dragging an old fridge from his kitchen to curbside 2 hours ago and a Ms. Doe, 27, comes with high fever, nausea, dirty looking urine and flank pain for 24 hours, it doesn't matter for any of them if they were abused, if they smoked at any point of their lives, if they were traveling in Western Africa within the last 21 days, or, as a matter of fact, why they are where they are and if they have any legal right to be there. They have medical conditions, and so they will be evaluated and treated according to EMTALA, and, if necessary, admitted. But the screenings for abuse, tobacco use, etc. are mandatory, so Mr. and Ms. Doe will be asked about these things first thing at triage because later on the Holy Screenings might fall through cracks and the hospital receive savage financial punishments for "not performing mandatory quality actions". If Mr. Doe would be brought back 6 hours later after his discharge with opioid overdose from those 30 Norco 10 he was prescribed, or Ms. Doe would be improperly discharged with Dx of uncomplicated UTI and readmitted soon with pyelo and urosepsis, the hospital will NOT be automatically punished for that (and even the possible lawsuits would target individual providers rather than facility as a whole).

Name it all as you please. It is a bureaucratic reality of medical care system we live with. On the better side, that's how population-wide healthcare interventions are studied and planned, and we all know that such interventions are saving lives by thousands. On the other side, answering those innumerable questions sucks. Especially if you're lying there with ETT fresh down your throat, your body feels like beaten dead after sux and everything you can do is to blink yes/no.

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A friend went to the ER, and while being triaged he was asked if he was a US citizen ( this was in the USA of course). Is this customary? I never recalled being asked when I was a patient, nor do I recall asking when I was a nurse. Is this the new normal?

Inshallamiami,

I had to look up a portion of your handle's definition "InShaAllah (Arabic: إن شاء الله‎‎ , ʾin shāʾallāhu; pronounced [ʔɪn ʃaːʔ ɑɫˈlɑh]), also in sha Allah or insha'Allah, is the Arabic language expression for "God willing" or "if God wills"...

Great combination....

Anyways, perhaps, the triage nurse suspected something wasn't right about your friend??? Regardless, it was inappropriate and irrelevant. Immigrations will only be involved once the police are involved, unless someone from the hospital rats a patient out anonymously. Probable... highly probable.

And puhleazzeee, have your friend report it.

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Specializes in Critical Care.
Full ED registration is usually not completed until after the MSE around here - in order to avoid any appearance of making MSE or treatment decisions based upon ability to pay. It's just less of a headache to not open the system up to that general accusation, I think.

At least in the four EDs I've worked in, and the others I've 'visited', it hasn't worked that way, and I'm having trouble imagining how it even would work that way or how there would be any advantage to doing it that way.

The first issue is that to avoid staff knowing a patient's insurance status, they couldn't be admitted to the EMR at all since most patients already have their insurance data connected to their MRN, which would mean either having everything regarding their ED visit on paper, and then transferring it to the EMR after the fact, or creating a john doe account for every ED patient, then merging them at some point.

The second issue would be that failing to appropriate provide a medical screening exam isn't any different if it was because the patient wasn't insured, the penalties and repercussions are the same regardless of why it wasn't done.

And since a large portion of ED patients are done with their visit after the medical screening exam, it would seem unlikely that every single one of them would continue to wait to complete their registration.

That all sounds like an incredible hassle and impairment to evaluation and treatment with no real advantages.

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A friend went to the ER, and while being triaged he was asked if he was a US citizen ( this was in the USA of course). Is this customary? I never recalled being asked when I was a patient, nor do I recall asking when I was a nurse. Is this the new normal?

Definitely NOT. They should not be asking this question, and this needs to be reported. There are nurses turning in patients to ICE, which is reprehensible. Administration needs to be notified, and if they are aware that this is going on, they need to come up with a plausible answer as to why. Hint, there isn't one. This is raw meat for the ACLU.

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At least in the four EDs I've worked in, and the others I've 'visited', it hasn't worked that way, and I'm having trouble imagining how it even would work that way or how there would be any advantage to doing it that way.

The first issue is that to avoid staff knowing a patient's insurance status, they couldn't be admitted to the EMR at all since most patients already have their insurance data connected to their MRN, which would mean either having everything regarding their ED visit on paper, and then transferring it to the EMR after the fact, or creating a john doe account for every ED patient, then merging them at some point.

The patient gives name/DOB and this is either nearly instantly matched with their existing record or a new MRN is created. Bracelet applied. Consent for tx signed. No other paper, no John Does. They feel it decreases the perception that they care more about financial information than what is wrong with the patient (thereby decreasing perceptions and allegations related to EMTALA violation) and, secondly, it meets the goal of being faster on the front end and relegating "full registration" to a point in the process where it literally isn't holding up anything.

All the rest of it, demographics, insurances, etc. etc. is completed by registration staff later. I don't think it was a originally a function undertaken to literally remain unaware of insurance status, but rather because it decreases perception of being discriminated against in this way and they have found a particular system to avoid this perception which is simply faster, besides.

The second issue would be that failing to appropriate provide a medical screening exam isn't any different if it was because the patient wasn't insured, the penalties and repercussions are the same regardless of why it wasn't done.

Well, perception matters. If you don't feel that you might be experiencing discrimination then you aren't very likely to report an EMTALA violation. Not addressing finances before the patient sees a physician is one way of trying to encourage positive perceptions. And CMS does make a distinction between LWOBS/AMA and other failures to meet the screening and stabilization requirements. Generally speaking, LWOBS manifests as an EMTALA violation only in particular circumstances (one of those a patient cites discriminatory activity as the reason they left). Last but not least, no one wants (well hopefully most don't want) patients to feel this way. We're there to take care of everyone and would prefer that patients have some confidence that we're doing just that. For that reason alone, I like this type of process.

And since a large portion of ED patients are done with their visit after the medical screening exam, it would seem unlikely that every single one of them would continue to wait to complete their registration.

I don't know how many people leave without the process completed, but I can only believe that places don't just decide to do something like this knowing that they won't be able to complete their own records or bill insurances, or collect co-pays. I would think missing any minimally-significant number of registrations would put nearly an immediate stop to this.

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