Triage sucks!!! Any tips??

[BrnEyedGirl]

Let me start off by saying I really do like my new position in the ER. It was a good move for me,....but how the heck does anyone spend 8hrs in triage w/out ending up feeling cranky, mean and down right nasty!!! It wears me out!! I'd rather stay on the trauma side a work back to back truamas all night than spend 8-12hrs in triage!! You just can't make most of those people happy!!! Last shift I worked was very busy,.rainy night,.lots of MVC's,..this adult woman walks in c/o abd pain, her Mom is with her,..I do my triage thing,.pt actually states she "feels much better now,.maybe I should just go home and see my reg Dr in the morning",.Mom says no,.you need to see a Dr. and asks me "how long is the wait?" Of course I can't really answer that question,..over the next hour a woman walks in with a 3wk old "help, help,.my baby isn't breathing",. sure enough I have a blue baby I rush back,..then a man who almost severed his arm w/a table saw,blood everywhere,.passes out in the floor in front of the triage desk,.rush him back,..a 6wk old "not acting right" temp of 104,.rush her back,..all of this in front of everyone in the waiting room,..then the Mom of the abd pain comes up and asks "how much longer are we going to have to wait?",.again I explain that this isn't first come first serve,.this is an ER,.we see the life/limb threatening emergencies frst,.she looks at me and YELLS "You mean to tell me that since my daughter isn't as sick as some of these other people, we could sit out her all night?!!",...uuuhhhh yeah,.pretty much!! Why is that such a difficult concept for people to understand???

ARGGGGGGGGGGHHHHHHHH,....ok,.I'll stop now,..anyone have any tricks on handling the people?

[Aliakey]

I really enjoy triage as well.

But, when things start getting busy and the waiting area is piling up, I dump the usual "What's going on today" question. The inital question asked of everyone who walks up to the window is changed to:

"What is your emergency?"

Of course, this first question is always asked professionally, clearly, and with purpose; never sarcastic. Quite a few patients are taken aback by just that simple first question, but I swear on the next Code Brown filled bedpan, there is a decrease in the number of folks who whine about how many others are going back instead of them. For some reason, I think a bit of perspective is shot into them about that daylong sore throat and what constitutes an "emergency". Never works for everyone, but any bit of relief helps on a busy Monday night.

[Jennifer, RN]

The "what is your emergency" is a line I am going to start using. Thanks!!

[StaceyFNP]

4 hour increments help the task of triaging not drive you completely nuts. It can also be entertaining. Try not to take it personally.

[AirforceRN, RN]

Hang a sign in the waiting room that says "Worst Come First Served" and then put one of those little number ticket machines underneath it...make sure the machine is broken.

[Victoriakem]

these are great! I have been working Triage, or the penalty box, several times over the past 2 weeks, & I find that by my vocal intonation when I call patients, it lets them know that I mean business when it's busy.

And I don't hesitate to inform them on how many people are waiting to be seen. "you're #25 on the list of those waiting to be seen" It helps weed out those who come rushing in with a little cut on their finger or "getting a check-up", as their CC. I'm nice & professional but don't cut any crap with me! Triage does make you feel mean & I find I have NO patience for BS of any kind. I even made my mother-in-law mad because I didn't want to look @ her normal lab work. Why!? It's normal, you moron, oops....

[RunnerRN, BSN, RN]

I actually enjoy triage quite a bit. It never fails to amaze me what people assume is an emergency. Plus, you only have to deal with the annoying crazy people for 5 minutes, then they're out of your room. I have also found that my skills have improved the more I work in triage - you really have to assess well and make sure that you really know what's going on.

I like the "what's your emergency" question. I also have no problem asking family members to step out of the triage booth for a moment, or pulling one of our very protective security guards over to my area. And while I don't let people pull any crap with me, I also have a caring attitude instead of being a ***** all the time.

Don't get me wrong, I have no problem being short with people who deserve it, but I am friendly, cheerful, and caring to those who don't. It makes them stare at you a lot less when they're in the waiting room 2 hours later.

[vamedic4, EMT-P]

I personally don't enjoy triage, but it's more of a language barrier issue for me. And I think that any organization that sticks you in triage for 8-12 hours without rotating you out is ridiculous.

I also disagree with piano's point of view...wholeheartedly. You want to get your @ss kicked by some parent or a patient, then go right ahead and get nasty with your patients. It will happen, I promise you. We all know the patient's aren't always right - but when you're being nasty, you open yourself up to confrontation. Many of these people have already reached their breaking point, you want to cross that line then you go right ahead. Roll the dice and take your chances.

It's fine to be firm and up front, but being unneccesarily confrontational will get you physically assaulted, and possibly fired. Some people don't take kindly to being treated like they're not "worthy" of an ER worker's time just because they're not bleeding from their carotid artery when they arrive.

There's nothing wrong with a little impatience, a short tone for someone deserving...but to walk around the ER with a chip on your shoulder in triage is asking for trouble.

The other thing is, you never know who you're treating. You might think this guy in your triage chair is a real bum, but he may just be the brother of the hospital CEO. I promise you, give him attitude and you'll be seeking employment elsewhere, and quickly.

Most of us on this board are lucky, in that we see things from only ONE point of view..that of the PROVIDER. Some of us have had the unfortunate experience of being on the OTHER side of the triage desk, and when nurse X is acting like I'm inconveniencing her with my failing VP shunt, it makes things that much worse. In my experience these are the people who don't listen when you tell them what's wrong. They don't listen, miscommunicate information, and this allows for unneccesary suffering or delays in treatment. It would do you a little good to give some the benefit of the doubt and just treat them like you'd want your mother treated.

Just my opinion...

vamedic4

It's warm here.

[reesern63, RN]

If someone asks right off the bat how long the wait is going to be that puts a little red flag up in my mind that they are more that likely going to be a PITA. I'd say to over estimate the time when they ask and remind them that life and limb emergencies take priority. That way when they do become a PITA you can remind them of what you've already told them.

Or if they ask which ED doc is working. Huge red flag. I never answer that one. I usually say, "I guess you'lll have to find out when you get back" or something like that.

[AmandaBrittainy]

I wouldnt say I love triage but it is my speciality. I don't feel like being nice to everybody or anybody sometimes but I would rather they complain about the wait time and the hospital than the triage nurse - keep that point in mind. You will never change the thought processes of other individuals - has anyone done it to you when you were absolutely convinced of something? The ones that complain the most you should not have to worry about (not always the case). Handle triage with confidence and let people know when your ER is full, you will only see people who would die otherwise and they they may have to endure a wait (with smile on your face). People will still be hateful and nasty but don't ever give them a reason to go after you because sadly in this society that is what they do - it would feel good to tell people exactly what you are thinking all the time but what difference will you make? They will get mad and not likely change thier perceptions. Besides you will be out of there in 12 hours and it doesnt really matter as long as you took care of business and helped those in need to the best of your ability.

[br107]

Different strokes for different folks I guess. When I was an EMT student doing my hospital rotation, I spent most of my day with the triage nurse. I thought the fast pace of things was pretty cool. I think I could do it all day, everyday. No problem.

[AM-RN]

i try to be pleasant to everyone. but also to convey to them that i am in charge of triage - not them. when people ask about the wait time - i let them know that all of our rooms are full and that as they become available the sickest people go back first. i also let them know that they are free to leave at any time and they are free to be re-assessed if they are feeling worse to see if they fit into a "sicker" category.

[teeituptom, BSN, RN]

I think about being on the golf course while at triage.