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ED Triage Role

lucypear lucypear (New) New

Hey Team!

I've been an RN for coming up 5 years now, the last 2 of them have been in ED. I love my job and this environment and my boss has told me today that in the next two months I am undertaking a triage course and will begin shifts in triage following that. (I'm lucky that in my workplace, I won't always be in triage, I'll be rotated to different areas each day depending on skill mix)

Whilst I am excited for this opportunity, I am nervous. I am nervous that I will miss something critical and patients safety will be at risk. I also work in a rough area, rife with gangs, and whilst our wait times are the best in our region people in this area still aren't satisfied with having to wait even 30 mins or so for a cough that they have had for 2 weeks.

So I was wondering, what advice do you seasoned triage nurses have for me? Note: We only have one RN triaging in our department per 8 hour shift.

NurseHeart&Soul, MSN

Specializes in ED, Critical care, & Education.

lucypear,

You are at a great advantage that your facility waited two years before orienting you. Add to that another 3 years of experience. You're off to a good start!

You will at times feel overwhelmed.....breathe and do the best you can. Even the most experienced feel overwhelmed at triage at times.

Soak up every bit of triage education that you can. Can I ask what type of education you get, how long, and how much time with a preceptor actually working at triage? What triage scale will you be using?

Seek as much triage education as you can for yourself. This is the time to embrace life long learning. There are some good triage reference books out there as well as Triage Facebook pages. Find support. Look for ongoing clinical education. Everything you learn will get used at triage...someday.

Know your facility policies. Follow them. When in doubt always consult with another nurse or physician. Trust your instincts, but only when it advocates for the patient. Leave any judgments at home. Every patient deserves a through and unbiased assessment. At triage things may need to be brief, but be unbiased. When judgment gets in the way you'll find those are the times you get burned (i.e. It's not "a drunk" but a guy with a head bleed.).

I could go on and on. Share your worries and maybe we can alleviate them. Triage can be a magical place where you can make a huge difference bringing calm to individuals in the midst of crisis. Have the right attitude, embrace the challenge, learn from your mistakes, and have fun!

JBudd, MSN

Specializes in Trauma, Teaching.

Sometimes when I get a really excited/anxious family member, who seems to think I am not taking things seriously because I am calmly doing my job, I just smile and say "I get paid not to panic".

Remember, you can overtriage about 30%, but undertriage should be less than 5-10%. Trust your gut; if they're sicker than the numbers show, call your charge and tell him/her so.

Don't let the "roughness" get to you, practice a bland look so when you are getting yelled at, they don't see a reaction. Don't buy into the drama. Call security if you feel threatened in the least. They don't know YOU from Adam, so any insults etc. are not personal, they are going after what you represent: authority, the facility, the fact that you are in control and not them.

If they are able to scream loudly, then they have a good airway! No resp distress! The ones you watch out for are the quiet ones, too sick to complain or do much, watch for color, lethargy.

Babies under 3 months with a fever, are as high a priority as a gunshot wound to the chest.

Lev, BSN, RN

Specializes in Emergency - CEN.

What type of triage scale/system does your facility use?

ICUman

Specializes in Cardiac Cath Lab.

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Babies under 3 months with a fever, are as high a priority as a gunshot wound to the chest.

Obviously a total noob here, but can I ask why?

Lev, BSN, RN

Specializes in Emergency - CEN.

Unvaccinated, immature immune systems, easily dehydrated

JBudd, MSN

Specializes in Trauma, Teaching.

As Lev said, very little to fight things off with, so if they do manage a fever they are at high risk for being really sick. Hypoglycemia happens fast. Babies just wear out fast, no reserves.

NurseHeart&Soul, MSN

Specializes in ED, Critical care, & Education.

High risk for turning septic due to the comments already given and just plain no reserves. I made this mistake as a new graduate nurse in triage. Fortunately the error didn't impact the outcome, but it was a teaching moment I will never forget. I'm glad we can educate NOW so none of you make this mistake LATER. Many facilities will say less than 3 months old and a fever greater than or equal to 100.5 F is a high risk patient. This patient will be a high level acuity (level 1 or level 2 based on presentation).

oldtiredmicn

Specializes in ER, Trauma, PreHospital, Teaching.

lucypear - I have a few things that I think can simplify this position and relieve some of your anxiety. I understand your feeling nervous about this. After many shifts as triage in Trauma/ED Level1 facilities and in high violence and high patient number facilities I learned some things the hard way. I can tell you all the horror stories of full waiting rooms, multiple serious patients, treating acute patients in the hallway in a wheelchair, and finishing a 12 hour shift and coming back 12 hours later finding some of the same patients still waiting to be seen! Things have changed drastically over the years and now those things are not quite so bad anymore (I hope)!

Common sense and your gut instinct make a large part of your triage knowledge. I again am speaking from years past but with alot of years (28+) experiencing, working with, supervising, and teaching this. Your certifications (CEN, MICN, ACLS, TNCC, PALS, EMT etc.) are ALL a good source for giving you confidence and a triage comfort level. Many question some of these as just "been there done that" titles - but they are more than that. They emphasize initial evaluation and prioritizing!

Some simple tips to work with:

1. Maintain always a calm, caring, professional attitude! You can be speedy but don't be hectic! It only increases tension.

2. Remember ABC's when evaluating a patient. Remember that they may not always tell you exactly whats going on. Look at the patient and evaluate what you see.

3. Touch your patient - feel their tension, their skin, their coolness or hotness. Squeeze their hand, look them in the eye, and show you care. Make it part of your exam - taking pulse, strength, following instruction, reaction.

4. Talk to the patient. Explain to friends and family that you are evaluating the patient but then listen to them also. Explain the reason for triage and eval that you are doing. Talk to them - don't be rude - explain things - sometimes this will alleviate problems and attitudes later.

5. You may be able to initiate some immediate care for there problem - a wheelchair, lay down on gurney, ice pack to injury, a temporary dressing, following protocols your department has.

6. Have good communication with you department charge nurse to know what beds are available, whats coming in by ambulance, what you have waiting.

7. Explain to waiting room and waiting patients why their is a delay, why other patients are going before them, etc.!

8. KEEP THAT CALM, CARING, PROFESSIONAL ATTITUDE! Be and advocate and communicate with your staff and patients. Try to keep family and friends in the loop!

Its not always comfortable, it's not always fun, and your shift may seem like the longest you ever worked! You can make it positive, you can help the patient and their family greatly, you are the initial welcoming committee for your facility. Be calm and enjoy!

Just listen to your gut. When a patient is really and truly sick and needs immediate care, you will know, you will just know. Also, some small things to remember.

1.) MIs can present themselves as mid-back pain, one patient was triaged to subacute for back pain and the PA did an EKG "just in case" and it showed he was having a STEMI...off to the cath lab he went. So in triage, keep that in mind and ask more detailed questions related to their cardiac well-being if a patient comes in with that complaint.

2.) Always take a peek at sore throats, and make sure the patient isn't drooling. If the epiglottis looks really swollen that's an immediate ESI of 2 for me (not sure what system you use but 2 means needing emergent care NOW). Airway airway airway.

3.) When patients come in with MULTIPLE complaints and they appear to be completely fine, make them choose one, the one that bothers them the most. You need to get some people focused, for the receiving RN and MD's sanity. If they truly have major complaints that are multiple, they will make it known, but some people just like to complain.

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