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How many pts should one nurse be reallistically expected to triage???

Posted

Specializes in M/S,TELE,ORTHO,ER. Has 14 years experience.

Question is, really I guess- how deep do you(or your mgmt)let it get in Triage/waiting room before you have more than one nurse? We used to have a policy more than five deep,waiting for triage, required the help of the Charge or PRN nurse. The other night I was 15 or more deep plus Waiting Room pts who need to be revitalized/reassessed for most of the shift.

Of course, this is not to mention the phone calls, registrars informing me of "chest pains","SOBs", etc,etc,crowd control(Why oh why is the security guard thinking I will let the party of 8 pass thru my ER to get to ICU?) AND pts/friends/family who are free to walk up to me at Triage desk and invade privacy of current pt. to ask "How much longer do we have to wait?"

Sign me,

Trying so hard to wear the big girl panties

gonzo1, ASN, RN

Specializes in CEN, ED, ICU, PSYCH, PP. Has 18 years experience.

It all depends on your ERs policies. There have been many days/nights when I had 15 waiting to be triaged. Some days are worse than others of course. And it depends on available staff.

What I do is keep plugging along and when a chest pain or obvious stroke, etc comes in I call the charge and they find them a room in the back. Might have to be a hall bed.

Everyone else just has to wait their turn.

Security where I work is great and doesn't allow any BS. Of course people constantly come up to the desk and ask how long.

I just remind them that people are not seen on basis of first come/first served, but rather acuity. This does make some people very mad.

Then they get to talk to security or the charge nurse.

I sometimes will look and say something like "The longest wait time so far is -----, your wait may be more, or less depending on what happens in the back"

Triage is a hard job. You have to have a thick skin and be able to recognize a seriously ill person that needs to go back immediately.

That said, I enjoy triage because I know I won't have to start any IVs, change any diapers, vomit, or intubate anyone during that shift. It is a pleasant decrease in responsibility for a change.

Fortunately I am good at knowing which patients are severely ill and need to go straight back.

I have discovered over the years that the sicker the patient, the quieter they are. So the abd pain that is eating chips and screaming at me for the long wait probably isn't very sick.

sweetsounds

Specializes in M/S,TELE,ORTHO,ER. Has 14 years experience.

Amen to everything you said. It's the call the Charge and he/she will get them a bed part that bit me...

The hall bed thing is a non-issue, since it has been going on forever. I don't mind statrting IVs, changing diapers, vomit, or intubating; I can handle one thing at a time as you said.

Anyway, just curious what the concensus of prudent nurses think.

Thanks

cookienay

Specializes in ER, education, mgmt. Has 18 years experience.

Sweetsounds- you can only do what you can do. To repeat gonzo, everyone else just has to wait their turn. THat being said, here is my philosophy of what a prudent triage nurse does.

1. He/she knows sick or not sick. You also have to know "sick but can wait an hour" or "sick and cannot wait 1 second".

2.He/she lays eyes on EVERY patient that signs in. I do not allow family to sign someone in while the patient goes to smoke. You can tell alot by just looking at someone. I also do not allow the techs to sign someone in. While they are great at what they do, they simply do not have the education/training to ask the right questions. I want to talk to every pt myself.

3.He/she keeps a cool head and thick skin. Never underestimate the stress caused by stupid people in large numbers.

4.He/she is accepting of the fact that sometimes you have to suck it up for patients who pull stunts. Like the patient with the ankle injury that has a "seizure" in the lobby that you then have to take straight back. (and then wait another hour in the hallway LOL). Or the lady with the migraine who says after an hour she is having chest pain. you get the picture.

5. He/she has a good working relationship with the charge nurse. Your charge nurse has to know that you are a prudent nurse and believes you when you say someone is sick. If you rush back a baby with a temp of 97.1 and tell me that the baby is not maintaining their temperature, I will roll my eyes at you. In a nutshell, your charge nurse can make or break you in triage.

All that being said, we have 2 triage nurses 12 out of 24 hours. If we need a second one the other hours the charge comes and helps or the manager on duty. There are days when 2 triage nurses can keep up, days when we can't. Sometimes we have to call in our call nurse to clear out triage. We have had 60 patients in the lobby or zero. Usually it stays around 20-30. Hope this helps you.

As I have said before... It is a hard job being the gatekeeper to hell.

twinmommy+2, ADN, BSN, MSN

Specializes in ED. Has 16 years experience.

All I keep saying to myself in triage is that you can only deal with the one patient at a time. And that pt can move out of the way if a train wreck rolls through the doors and then only deal with that one. You will catch up at some point or another but for right now just keep plugging along. And don't look at the clock what every you do unless you have to write a time down and then forget the time. Don't be a clock watcher it will stress you out. Sometimes I catch myself doing "damn its two more hours left in my shift out here and have a gazillion charts left and will never catch up" it takes a toll on your stress level doing that. Just plug away one at a time. It will all get done.

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