Er nursing and stress

[SnickerDoodle_RN]

So I've been in ER for a little over a year and I've been triage for a few weeks now and I'm having a hard time with all the stress. Due to the dynamics of our ER right now I am often placed in Triage all night long. Recently I worked a really tough shift where it felt like every patient was critical and I noticed multiple occasions where I could have done things differently and they weigh heavily on me despite no adverse harm coming to my patients. Overall I work with an amazing team and no one is punitive but I still feel hard on myself. Has anyone been through this, particularly with triage? I just feel like I either need to get better or get tougher with dealing with these things.

[JKL33]

If you have a supportive team and no one is punitive, you're golden/good to go. Seriously. Do your best, asked trusted peer mentors to talk through scenarios with you as time allows. Visit with your educator. Review your triage manual and algorithms so you have them down pat. Be aware of both forest and trees; these go into context together, not separately. Don't be afraid to consult your CN in real time if you are really concerned about your decision choices.

It's overwhelming at first, but it sounds like you are being accepted as a beginner in this area and that's really worth a lot. You'll be amazed what NewRN24 looks like as a triage nurse a year from now. Triage is another one of those things that (only) book learning can't properly teach. There's a rhythm to it and if you're striving to do your best, it's likely that making good decisions will become rather automatic with experience.

Feel free to write more here if you want to talk about your experiences more, or PM.

Best wishes ~

[Lunah, MSN, RN]

One of our surgeons likes to remind us that hindsight is an exact science. It's so true! But there are many things in the clinical picture that we can't know without later results. Like that guy with the back pain who was really a rupturing AAA. All we can do is consider what we see before us (sick vs. not-sick), vitals, and history.

I remember when I started in triage, and my head would whip around toward the door every time it opened, I was so hypervigilant! Then I came to realize that I knew how we'd handle those potential life threats - those things that involved the brain, heart, lungs, or catastrophic bleeding. I also realized that my team was always in the back and ready if something life-threatening came through the front.

As to the more subtle things, the picture is a little more blurry and requires more investigation. Is it a potentially surgical abdomen? Atypical MI presentation? Those are the sneaky ones! And if the person is a bounce-back or was recently discharged, keep your antenna sharp. Recent surgery or a new postpartum mom? Potential for bad stuff.

We called it the penalty box, but I admit that I love triage.