Do you have an ED "greeter"?

nightbrightener · Oct 4, 2017

We do have volunteer greeters, it is mostly college students or retired people. They generally offer warm blankets, bring wheelchairs as needed to patients and do general customer service skills. Most work in the lobby, a few work on the floor itself and do much the same, offer blankets, drinks if able and for a while we had a cart with magazines and books for patient to read that was wheeled around. Honestly it seemed to go well for the patients, and our customer service numbers (PRESS GAINEY) have always been good, but no real "medical" exposure for the greeter, and honestly most of the nurses were not super receptive to being told the patient in bed 8 wants pain meds, when in fact you don't have bed 8 and they are a seeker anyway. We use a pager system to call them when they are being roomed so if they roamed off the pager should still work, if not, good luck tracking them down since we get enough patients it would be hard to remember a face for the name. It will get you exposure to the ED, but honestly trying to get in as a registration or patient care assistant/tech would probably get you alot more exposure.

Role suggestions:

offer wheelchair on arrival or form parking lot if practical

offer warm blankets while in waiting room

offer drinks- messy because pt's NPO until seen by doctor

wheel patients back to lobby

offer magazines or books (although cross infection/contamination an issue)

bring visitors back to rooms

ItsThatJenGirl, CNA · Oct 4, 2017

Great ideas, thank you!

JKL33 · Oct 4, 2017

Sounds like a great opportunity; I agree with the PP's experiences and the 6 items/suggestions already mentioned are about exactly what I'd suggest too.

People do "wander off," - to smoke, hit vending machines and who knows what else. I'd be curious how they plan to involve the greeter in that issue. It's something that could become contentious if they expect you to try to stop people or warn them against leaving, KWIM? I'm just trying to imagine what that would look like, because a lot of places are also reluctant to try to tell people how long the wait will be (especially if it's on the longer side) or "where they are in line" because then people want to leave and go somewhere else, and EMTALA worries enter the picture.

A couple of other things you'll want to know details about:

- How they plan to ensure your safety. It would be ideal if you were kind of working in tandem with security, with the volunteer tending mostly to hospitality items and security attending to situations that can turn dicey quickly.

- Pay attention for any suggestions that are inappropriate for the role being designed. Every once in awhile, in seeking to make the most out of the opportunity for a new role, someone will make a suggestion that is simply outside the scope of that role - - such as, I could see someone saying, "Hey, and while they're out there they can be an extra set of eyes..." Well, no, a volunteer is not there to make sure people aren't shooting up in the WR bathrooms, for example.

- I would suggest they route all complaints or patient concerns about condition (which you absolutely will hear/receive if you're hanging out in the WR) directly to the triage nurse, or whatever their practice is right now without volunteers. All of that should be kept completely separate from the greeter role; trust me when I say that you don't want to be put in a position where you're expected to call back into the department every time someone reports that their ankle pain has now just morphed into chest pain and they need to be taken back immediately. :- /

I don't think it'll be too boring, one way or another! :)

ItsThatJenGirl, CNA · Oct 4, 2017

Sounds like a great opportunity; I agree with the PP's experiences and the 6 items/suggestions already mentioned are about exactly what I'd suggest too.
People do "wander off," - to smoke, hit vending machines and who knows what else. I'd be curious how they plan to involve the greeter in that issue. It's something that could become contentious if they expect you to try to stop people or warn them against leaving, KWIM? I'm just trying to imagine what that would look like, because a lot of places are also reluctant to try to tell people how long the wait will be (especially if it's on the longer side) or "where they are in line" because then people want to leave and go somewhere else, and EMTALA worries enter the picture.
A couple of other things you'll want to know details about:
- How they plan to ensure your safety. It would be ideal if you were kind of working in tandem with security, with the volunteer tending mostly to hospitality items and security attending to situations that can turn dicey quickly.
- Pay attention for any suggestions that are inappropriate for the role being designed. Every once in awhile, in seeking to make the most out of the opportunity for a new role, someone will make a suggestion that is simply outside the scope of that role - - such as, I could see someone saying, "Hey, and while they're out there they can be an extra set of eyes..." Well, no, a volunteer is not there to make sure people aren't shooting up in the WR bathrooms, for example.
- I would suggest they route all complaints or patient concerns about condition (which you absolutely will hear/receive if you're hanging out in the WR) directly to the triage nurse, or whatever their practice is right now without volunteers. All of that should be kept completely separate from the greeter role; trust me when I say that you don't want to be put in a position where you're expected to call back into the department every time someone reports that their ankle pain has now just morphed into chest pain and they need to be taken back immediately. :- /
I don't think it'll be too boring, one way or another! :)

Amazing advice, thank you!!

adventure_rn, MSN, NP · Oct 11, 2017

Oh geeze. I volunteered in a similar ED 'greeter'-type roll (we called ourselves 'Ambassadors' which I thought was kind of geeky). We primarily worked in the unit once patients had been taken back, but we occasionally rounded on the waiting room and I always dreaded that part because there was hardly anything we could do for them out there.

We couldn't bring food to patients in the waiting room in case of NPO status, and we couldn't bring linens or food for families out into the waiting room due to cost constraints (we were a low-budget community hospital in a bad part of town). There also wasn't any privacy in the waiting area, so people didn't want to sit and talk like they might if they were back in a patient room. Usually the only thing people would ask was, "When am I going back?" which we obviously couldn't answer, or, "Can you double check with the triage nurse to make sure I'm still on the list?" which was pretty annoying for the triage nurse. Before you implement the program, I'd definitely have a system in place to address those questions (either by having a way to check it yourself without bugging the nurses, or a consistent message that,"I'm sorry, I don't have any of your patient information, you'll need to ask at the front.")

I actually found that we were quite useful in the ED. We could convey basic messages between patients and staff (i.e. "Room 4 needs to go to the bathroom," "Room 11 is asking for more pain meds," or "Your nurse is in another room, but she'll be right with you"), we could provide food/drinks after checking NPO status with staff, we could get pillows and warm blankets, we could act as runners to bring medical supplies, we could show patients how to use the public phone, we could walk families to the cafeteria, we could wheel discharged patients out to the main entrance, and we could offer therapeutic communication (our rooms didn't have TVs, so patients would get pretty bored). I felt really helpful once patients were brought back to the ED, but none of these services really translated well to our particular waiting room.

JKL33 · Oct 11, 2017

I actually found that we were quite useful in the ED. We could convey basic messages between patients and staff (i.e. "Room 4 needs to go to the bathroom," "Room 11 is asking for more pain meds," or "Your nurse is in another room, but she'll be right with you"), we could provide food/drinks after checking NPO status with staff, we could get pillows and warm blankets, we could act as runners to bring medical supplies, we could show patients how to use the public phone, we could walk families to the cafeteria, we could wheel discharged patients out to the main entrance, and we could offer therapeutic communication (our rooms didn't have TVs, so patients would get pretty bored). I felt really helpful once patients were brought back to the ED, but none of these services really translated well to our particular waiting room.

Every ED should staff this type of role; I sure wish they would.

adventure_rn, MSN, NP · Oct 11, 2017

Every ED should staff this type of role; I sure wish they would.

I agree! It really was mutually beneficial for everybody involved (nurses, patients, admin, and volunteers). The incredible nurses I worked with were the reason that I first considered nursing rather than medical school, which is the best decision I ever made. We always had more applicants than positions available due to the abundance of eager pre-health students.

ItsThatJenGirl, CNA · Oct 13, 2017

Thanks for the input! I really appreciate it!

ItsThatJenGirl, CNA · Oct 24, 2017

Finally had my first shift last night. It was pretty terrible. I got spit on and yelled at multiple times - in a short 4 hour shift.

Basically my job is to get people that have had their initial triage done, and take them back to the billing office - which no one wants to do.

It's a standing weekly shift, so I'll go back and do what needs to be done - I just need to figure out how to armor myself better against patients that are openly taking advantage of me. I'll get there.

adventure_rn, MSN, NP · Oct 25, 2017

Finally had my first shift last night. It was pretty terrible. I got spit on and yelled at multiple times - in a short 4 hour shift.
Basically my job is to get people that have had their initial triage done, and take them back to the billing office - which no one wants to do.
It's a standing weekly shift, so I'll go back and do what needs to be done - I just need to figure out how to armor myself better against patients that are openly taking advantage of me. I'll get there.

Ohh noooo! That stinks. :wideyed:

Just speaking from my own experience as an ED volunteer, I think things will get better. 90% of ED confrontations tend to fall into a discrete set of scenarios (I'm mad because this is taking so long, I'm mad because I feel ignored, I'm mad because I didn't get the pain pills I want, I'm mad because I'm NPO and I haven't eaten in 8 hours, etc.) As you practice, you'll figure out the best response to these inevitable uncomfortable situations with an internal script for the different common scenarios.

In my experience, many people in the ED just want to feel as though their frustrations are being validated. They feel sick, tired, and miserable, and want the ED staff to acknowledge and appreciate those feelings.

If I could sense that a patient's frustration was escalating, I usually used this script: "It sounds like you're feeling very frustrated/upset/ignored. Can you tell me more about it, and I'll see if there's anything I can do to resolve the issue?" Usually once people were able to express their frustrations and felt as though someone actually cared they would calm down, even if there was literally nothing I could do to improve the situation. (However, if you feel that your safety is being compromised, immediately remove yourself from the situation and get help; this probably goes without saying, but just wanted to throw it out there).

It might not always feel like it, but the work you're doing is important and valuable. Learning how to respond to these scenarios will be so advantageous when you start out as a new grad nurse; when I applied for new grad jobs I actually made the emotional maturity I learned from my ED experience a hallmark of my applications, and it was a big hit. Also, as you demonstrate your value to the ED staff, they may allow you to become more involved 'behind the scenes' as I described in my earlier post.

Best of luck! Keep us updated, and let us know if there's any way we can help. You've got this!

JKL33 · Oct 25, 2017

Finally had my first shift last night. It was pretty terrible. I got spit on and yelled at multiple times - in a short 4 hour shift.
Basically my job is to get people that have had their initial triage done, and take them back to the billing office - which no one wants to do.
It's a standing weekly shift, so I'll go back and do what needs to be done - I just need to figure out how to armor myself better against patients that are openly taking advantage of me. I'll get there.

Oh no! My best advice for your first paragraph is to never reply in kind, that is the basic rule. Keep yourself emotionally separated from the words you hear spewing forth. This is such a great opportunity to practice skills that you will need to have well in hand as an RN. Look at yourself as a student of social pathology.

This next comment is not in regards to your responsibilities - but I'm curious whether these triaged patients who are going to billing are waiting in a backlog of patients that need rooms. If they are, that's one thing, but if they just by convention go to billing before going to the treatment area, that is a situation ripe for EMTALA violation. Personally I think it's an unfortunate set-up either way; I can almost guarantee you it isn't helping their satisfaction scores. Again, I know that's not on you - but hey, you can be informed and ready in case you have an opportunity for input!

I look forward to your next update!