Triage sucks!!! Any tips??

  1. 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?
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    About BrnEyedGirl, BSN, MSN, RN, APRN

    Joined: Nov '06; Posts: 1,274; Likes: 1,843
    RN, CEN, FNP-C ER Trauma Center
    Specialty: 18 year(s) of experience in Cardiac, ER


  3. by   Ariesbsn
    Boy, since sarcasm and laughter will only get you in trouble, and tazering a person would be battery, I would suggest silent prayer (don't want someone who is not religious claiming that you violated their rights by praying in front of them).
  4. by   TRAMA1RN
    just a note. Unless you work for a union you need to learn to be nice to everyone all the time no matter what. Smile and remain calm. I too hated triage but if enough patients complain and you for for an "at will employment" employer you can be fired for no reason and if customer service is your number one goal as it is at most facilities you could find yourself out of a job. So take a deep breath and relax and smile and remember that yu can do anything for 8 hours.
  5. by   Jennifer, RN
    Triage sucks. I would love to be able to tell the pts that complain about the wait that emergent pts get to the back first, and since you are not going back right away (or probably any time soon) then you are not emergent and you should be thankful. But, in reality, I smile, apologize for the wait, explain that we are trying to get them back as soon as possible but we have had quite a few critically ill pts come in that require immediate attention.
  6. by   schroeders_piano
    Triage can suck if you let it. I always had blast in triage. I disagree with the being nice to everyone. I wasn't. When they came into my triage room, I did not give a flip about their life story or what was going on 3 weeks ago. If they got off track from the questions I asked them, I immediately put them back on. If anyone ever yelled at me, I gave them a warning to settle down. If they did not heed that warning, then they got to talk with MR. Security Guard who "kindly" explained the workings of an ER. If they ever asked me how long the wait was, my ER's standard answer was 3 hours or more, whether it was or not. Some of our patients needed a theraputic wait and our ER director insisted that it happen. Don't let triage get you down. Be cranky and mean, it might sway some people from needlessly using the ER for hangnails and coughs.
    Last edit by schroeders_piano on Apr 16, '07 : Reason: spelling errors
  7. by   Jennifer, RN
    "Don't let triage get you down. Be cranky and mean, it might sway some people from needlessly using the ER for hangnails and coughs."-schroeders piano

    I agree with this completely. I also think that everyone that comes to the er should get an iv, lumbar puncture and pelvic exam. This would really dissuade people from coming back.
  8. by   Flare
    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.
  9. by   CHATSDALE
    disagree with piano, do assessment..some of the frequent flyers and/or the ones you don't believe at first glance are in need of care
    in a hospital here in town a patient came in and c/o of a 'tummy ache' was put on low priority and about an hour later other residents were screaming and the guy was convulsing on the floor...had a constricted bowel
    hopefully with a little seniority yo can be moved into an area that you enjoy more
  10. by   rgroyer1RNBSN
    Quote from Jennifer, RN
    "Don't let triage get you down. Be cranky and mean, it might sway some people from needlessly using the ER for hangnails and coughs."-schroeders piano

    I agree with this completely. I also think that everyone that comes to the er should get an iv, lumbar puncture and pelvic exam. This would really dissuade people from coming back.

    I agree with you Jennifer, I have worked in er alomg time I was fist a tech, then an LPN in fastrack now Im an RN and we rotate on doing triage in my er, each nurse at least gets one night a month if not 2. So yes get cranky and mean and nasty I do so do alot of the other senior clinical RN II's, fancy way of saying weve worked the pit for along time or ICU, and were generally the charge nurses. I work triage at least twice a month and you have to get mean and cranky to get anything through the morons thick skulls. Yes I also think everyone should get an Iv 14 or 16 gauge even a hangnail because you know they might need abx for infection, a lp, and a pelvic ( now in the case of males well make it a rectal or a foley), I also think that anyone complaining of abd. pain if we know there faking or seeking need an NG tube dropped.
  11. by   Ginger35
    I have done traige many of times at a very busy ER that at the time seen about 230 patients a day on average. It was very hard after even 10 minutes to keep a decent demeanor. However, being nasty and mean can cause problems with patients that tend to get physically abusive.

    I think it is important to set realistic time lines about getting back to the ER rooms - and if that means padding the time so you can do what you have to do - then so be it. However, when the crowd gets backed up in the waiting room, you can easily see how this can turn into an angry mob.

    Unfortunately, most people don't understand the concept of triage. I do agree with the above regarding large bore IVs, LP's, enemas et al. The truely ill patients that require the ER need these things sooo........
  12. by   TRAMA1RN
    Our ER sees 60,000 visits yearly We do triage in 4 hour increments, almost everynight you will be at triage for at least 4 hrs, sometimes 8 and sometimes 12. You have to be respectful and nice to everyone because trust me, mamagement changes and before you know it patient complaints can get you fired. I've seen it in our ER.
  13. by   Medic946RN
    I must be strange because I love working triage. It's almost as autonomous as working in the field. You get to examine, diagnose and sometimes treat if there are established clinical pathways. Sure you get the moaners, complainers and rude patients, but they can be fun too if you know how to manipulate them.
  14. by   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.