I have a question for ER nurses

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Specializes in Corrections, Cardiac, Hospice.

Quick background: Our hospital recently opened a free gym to workers right outside the ER. I was taking one of the nurses over for a quick tour (your badge must be activated to get in) last night. We walked out the doors and found a young woman holding her dh upright. He was huntched over and couldn't stand up straight to help her at all. I was thinking appendics... The other nurse ran to get a wheel chair and we helped them into the hospital. I went into the triage room and told the nurse in there what happened and that he was in a lot of pain. She said ok, where is he? I told her and we left. We were over the gym for about 5 minutes and when we came back, the guy was where we left him. I asked his wife, has anyone seen him yet? She said, no, they haven't come out of that room at all. I went in and reported it to the supervisor. Now, my question is this, if another nurse (I am a supervisor on my unit and it says that on my badge, not that it should matter,) came to you and said there is a guy I just wheeled in out in the hallway, huntched over in a lot of pain, I think it could be his appendics... Would you not go at least check the situation out? Was I out of line for going over her head when he hadn't been seen in 5 minutes or is that unreasonable? I could just be use to floor nursing, where if someone complains of pain we are addressing it right away. Just wanted some thoughts from experienced ER nurses.

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Specializes in Emergency & Trauma/Adult ICU.

My first question would be, where in the hall did you leave the pt.? Somewhere within the ER waiting room/triage area? Just trying to get a mental picture of the situation ...

Secondly, what was the triage RN doing in that 5 minutes? Was he/she walking back another pt., perhaps, who was obviously SOB, or c/o chest pain, nausea & diaphoretic?

I agree that pain always needs to be evaluated, and correlated with other symptoms. But I doubt it's unique to the ER world - people can, and sometims do, put on Academy Award winning performances, (with the cooperation of family members), in order to get meds. I'm not saying that was the case, only that it was one of 100 possibilities.

At the opposite end of the scale, I've had an elderly pt. c/o abdominal pain who was to get 2mg morphine for pain relief while lab tests were pending, and her family strongly objected: "What if she just has a stomach virus, and you're giving her morphine!" Sometimes you just can't win.

Obviously any comments here will be like a "Monday morning quarterback" -- just trying to get a better feel for what went on.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Yep, my first question was where did you leave the pt?

When you found the pt, were they inside the hospital or off of hospital grounds? (even if across the street). This also makes a difference in things because if they were off hospital grounds, you could have called 9-11 and the pt would have had EMT/Paramedic help while they waited for the ED or if the ED was full...transport to another facility...

I agree with MLOS, the triage RN may have been assessing something that needed immediate care, and can't leave a patient to assess another before their assessment and communication is done. And five minutes to do all that isn't very long (remember all the questions for an ED Triage just for a standard assessment is LONG...bless their hearts for doing it as quickly as they do).

Not to say your Pt wasn't to be assessed for a serious condition right away...but there is an order to the madness we see in ED's...even if we don't see it in the lobby (there is a whole new world going on chaotically most times in the back ;) ).

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My other question would be What are his skin vitals? pink,pale,warm,cool,dry clammy...???

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Specializes in Corrections, Cardiac, Hospice.

Keep in mind, I am an old corrections nurse. I have seen faking by the BEST of them, lol. What led me to believe he was not faking the pain is the fact his back and that of his wifes was turned to us when we walked out of the hospital. They didn't call out for help, we approached them to see if we could do anything for him. Also, he was pale, shakey and clammy. As far as his cool skin, well, it is Jan in Northeast, Ohio, lol.:rotfl: The thing that made me angry was, she didn't trust MY judgement. I went into her and said, you really need to take a look at this guy. She was in the middle of stocking gloves in the cupboards, btw. It probably didn't help any that the nurse with me was an old ER nurse and had just gotten done telling me that the one working triage was hard core:uhoh3: I had left him in the hallway, right outside her door, so would it have really hurt to peak her head out and see what I was talking about?

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Not trying to stir things up but I have to ask......

Why was "taking a tour" of the new gym more important than the patient that was in pain? Maybe she was mad that you were telling her to take care of the patient while you went off the unit....

Just a thought, like I said, not trying to step on anyones toes....just wanting to put that out there.......

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Not trying to stir things up but I have to ask......

Why was "taking a tour" of the new gym more important than the patient that was in pain? Maybe she was mad that you were telling her to take care of the patient while you went off the unit....

Just a thought, like I said, not trying to step on anyones toes....just wanting to put that out there.......

Shay doesn't work in ER. If you'll look at the first post it is explained that Shay is a sup in a different unit.

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opps! my bad! I read that but it did not register.......SORRY!

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like others have said the traige nurse may have been caught up with a chest pain a sick child............ when i worked in ER you would always get people that cam in ..." my friend is in pain or there in the car and i cant get them out" 9 times out of 10 it is just an attempt to get seen quicker......that said i have seen people caught out when they went out with that attitude and the person was really sick or dead

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Specializes in ICU,ER.

I would have probably tried to see that pt. pretty quickly if I were triaging. However, 5 minutes is not really a long time....it takes that long (or longer) to get a pt. registered with the admission clerk. Did you see the wife? Was she getting him registered? To make up an ER chart at a lot of places, a pt. needs to be in the computer.

Also, as another poster said, sometimes people get dramatic to get seen quicker. There was this one woman that always presented to the ER wanting "detox"...she refused to follow up.... but she would flop around in the floor in the waiting room, making a huge production. I am sure the other people in the waiting room thought we weren't being as proactive as we should be.

I am not in any way assuming this man,in the incident you witnessed, was not sincere..... only saying that, as an outsider, you may not know the whole story.

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Specializes in ER.

If she was in the middle of a crisis and saw your badge she probably assumed that if he was in the process of dying you'd either call a code or stay with him, otherwise it makes sense for her to finish one thing before starting another.

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I have been in the situation at triage where nurses or other staff from outside ED/ER have brought patients to triage. As Shay said, at the time the triage nurse was stocking cupboards so there is really no excuse for not seeing the patient sooner than 5 minutes - although some other patient may have arrived. But even then the triage nurse should have at least looked at him to see who should be triaged first.

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