would like opinions on this letter please

[kermitlady]

Recently, I had reason to take my son to the ER. I was not pleased with the triage nurse. The hospital sends out satisfaction surveys to patients and I am sending this letter back with it. I would like the opinions of other nurses before I officially mail it in. Thanks for taking the time to give me feedback!

Sorry but this is a bit long.

To Whom It May Concern:

On Sunday, January 24th, 2009 around 7:30PM, I brought my three year old son into the Emergency Department. Dr. _____and ________, RN were very helpful and compassionate. Amanda did everything she could to make this visit easier on my son.However, I was greatly disappointed in the triage nurse. I am sorry to say I do not remember her name.

I had just finished working a 12-hour shift myself, so I was somewhere between nurse-mode and mom-made when we arrived in the Emergency Department. If I had been thinking clearly, (what mother does when her child is ill?), I would have written “difficulty breathing” on the triage slip. Because I was still thinking like a nurse, I wrote “sternal retractions”.

The triage nurse was taking vital signs and assessing another patient when we walked in. When she was finished with that patient, she looked at my son’s triage slip, placed it on the bottom of her stack, and proceeded to call the next name from the top of her stack of triage slips. At this point, I did interject, stating my son was having trouble breathing with sternal retractions. The triage nurse then looked at the woman whose name she called – for all intents, it appeared as if she was asking permission to see my son first.The woman did seem to understand, telling the triage nurse it was okay with her if my son was seen first.

The triage nurse did see my son next. She never looked beneath his shirt to see if my assessment of sternal retractions was accurate. However, when his Oxygen saturation would not come above 91% in triage, she did take my son back to a room immediately and had respiratory therapy paged.

Once in a room, _______, RN came in to assess my son and placed a pulse oximeter on his finger. I watched this very closely. His O2 saturation dropped to 86% before the respiratory therapist arrived. Normal O2 saturation should not go below 92% in a healthy person. What would have happened if the triage nurse had made my son “wait his turn” while she went through her triage slips in order?

I understand that I do not know why the other people in the waiting room were there in the ED. I also understand that some people will make their reason sound more severe to be seen quicker. However, every nurse SHOULD know that the ABC’s always come first: Airway, BREATHING, and Circulation. I feel the triage nurse that night did not follow this rule of nursing. When she saw the words “sternal retractions”, which are a cardinal sign of respiratory distress in pediatric patients, she should have at least looked at my son’s chest to see if I were making a correct assessment

Thankfully, my son is okay and a week later he is a normal, healthy little boy. As I stated in the beginning of this letter, Dr. _____ and ________, RN were quite helpful. ________ went out of her way to make the visit easier on my son, including pretending the pulse oximeter on his finger was a duck. However, I shudder to think what could have happened if I had had no training as a healthcare professional and thought the triage nurse knew what she was doing my making my son “wait his turn”.

Sincerely,

kermitlady

[FireStarterRN, BSN, RN]

Your letter seems to describe the situation well. I'm glad he's doing better. Hopefully your letter will help the hospital improve.

[kermitlady]

Thanks for your input.

[HonestRN]

I think the letter is well written, describes what you experienced without attacking the triage nurse personally.

[matilda123]

I am confused about why you are complaining. Are you upset about a "what would have happened"?. It didn't happen, you clarified and got him seem next,and he was treated and is o.k.

[Altra, BSN, RN]

I am confused about why you are complaining. Are you upset about a "what would have happened"?. It didn't happen, you clarified and got him seem next,and he was treated and is o.k.

Agree. You state that your son was triaged ahead of the other woman, was taken directly to a room, and treatment initiated. What, in your opinion, was inappropriate about that scenario? Do you know what the other patient's chief complaint was? Do you know that it wasn't chest pain, or stroke s/s? No, you don't.

[SunnyAndrsn]

I think your letter is well written, go ahead and send as is...but think about the people on the other end receiving it. What do you think they are going to think? What do you hope the outcome will be?

[leslie :-D]

i think a letter, sharing your concerns over an er nurse not knowing what sternal retractions are, and its potential implications, is reasonable.

but that should be the main point, and not 'what would have happened'.

oh, minor edit.

mom-made s/b mom-mode.

leslie:)

[Katie82, RN]

I would not send that. The outcome was satisfactory because you advocated for your son, as you should have. I have done this many times for my children. The Triage nurse made an error in judgement, but you corrected it. Hers is not a job I would like to have in today's ER setting. I would have been more angry if it had been a clerk sitting at a desk filing her nails, but you said yourself that she had a stack of triage sheets. This was a good lesson for you too, next time a simple "shortness of breath" will have more impact - those patients always get seen first.

[Smokey9283]

I think that the triage nurse did a good job. She listened to you when you spoke up about your son's condition, and did everything she should have done after assessing him. She doesn't need to actually see the sternal retractions to know that he was in respiratory distress, it was evidenced by his sats. Regarding the point of what might have happened if you had not been a medical professional, you wouldn't have written sternal retractions on the triage slip because you wouldn't have known what they were. In our emergency department we tell our patient's and families that if they or their loved one has a change in condition, then they should inform us immediately. Triage nurses only have a couple of minutes to assess each patient. You should leave it be.

[kermitlady]

I am confused about why you are complaining. Are you upset about a "what would have happened"?. It didn't happen, you clarified and got him seem next,and he was treated and is o.k.

I am upset because the triage nurse did not appear to take my complaint seriously and when I did point out that my son was having difficulty breathing, she looked to another patient as if for permission to see him next. She was the triage nurse, which by definition means she decides who is seen next, not another patient.

[kermitlady]

I think your letter is well written, go ahead and send as is...but think about the people on the other end receiving it. What do you think they are going to think? What do you hope the outcome will be?

What do I want the outcome to be? That the triage nurse is to take all complaints seriously. If she sees something written on a triage slip like "sternal retractions", that she get up and look at the kid, not just shove his slip to the bottom of the stack.