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”.
Well, I knew someone who, when upset with something, she'd write a note about it. Never meant to send out the note, just.........wrote one. She'd wait a week, read it and see if she felt the same. A lot of times she was......not as burned up as she acted in the letter. Sometimes she still felt the same.
Thats what I'd do. Wait a week, see if you still feel the T-nurse could have done better. If you still think so, send it. If not, pitch it.
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.
My problem is that she did NOT want to take my son next. She looked to the next person in line, as if asking permission for my son to be seen next! To be honest, that royally pi$$ed me off. She is the triage nurse, the one who decides who is seen next; it's not first come, first serve. If she can't handle having the next person who walked through the door angry at her b/c she deemed someone else needed to be seen first, she shouldn't be sitting at the triage desk. I know that sounds harsh, but it's the truth.
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.
If this is how you see it, then send the letter. You have a right to voice your complaints. If you think what happened was important enough to write about it, then that is your decision. Frankly, with the stuff that happened to me when I've been hospitalized, I'm just happy to have gotten out of the place to recuperate elsewhere. I still suffer from PTSD from one incident. No amount of letter writing to complain is going to help me. But I can see where you would feel the way you do, so you should act upon it.
What is your goal with sending the letter? I'm sure her intentions were not to ignore you but to prevent a scene from occuring had she not seen the patient before you. That's probably why she looked to the other patient. When you pointed out her error, she assessed your son and took him back to be seen by the RT and the doc. I'd be happy with that.
Well, I knew someone who, when upset with something, she'd write a note about it. Never meant to send out the note, just.........wrote one. She'd wait a week, read it and see if she felt the same. A lot of times she was......not as burned up as she acted in the letter. Sometimes she still felt the same.
Thats what I'd do. Wait a week, see if you still feel the T-nurse could have done better. If you still think so, send it. If not, pitch it.
That was my idea, it's been a week since we went to the ER and it'll probably be another week until I send the letter.
What is your goal with sending the letter? I'm sure her intentions were not to ignore you but to prevent a scene from occuring had she not seen the patient before you. That's probably why she looked to the other patient. When you pointed out her error, she assessed your son and took him back to be seen by the RT and the doc. I'd be happy with that.
My point in sending the letter is to make sure that nurse understands the implications of ignoring a serious complaint and hopefully preventing a repeat occurrence. I saw the nurse look at my triage slip but not my son. She acted as though it was not a serious complaint when it could have been life-threatening.
What is your goal with sending the letter? I'm sure her intentions were not to ignore you but to prevent a scene from occuring had she not seen the patient before you. That's probably why she looked to the other patient. When you pointed out her error, she assessed your son and took him back to be seen by the RT and the doc. I'd be happy with that.
I just wanted to add that I'm trying to look at the situation from a different perspective. If it was my kid, yeah I would have spoken up too. My point is, you corrected her.
Traumanurse07, are you trying to say that I made her feel bad by correcting her? If that is the case, I absolutely do not feel bad in any way about the whole ordeal. My point is that I shouldn't have had to correct her.
As others have pointed out, I don't know what the other patients in the waiting room were there for and I did put that in my letter. What I failed to include is that the triage nurse was talking and laughing with other staff. If there had been someone there with s/sx of a stroke or MI, I wouldn't have expected her to be so laid back.
Traumanurse07, are you trying to say that I made her feel bad by correcting her? If that is the case, I absolutely do not feel bad in any way about the whole ordeal. My point is that I shouldn't have had to correct her.
As others have pointed out, I don't know what the other patients in the waiting room were there for and I did put that in my letter. What I failed to include is that the triage nurse was talking and laughing with other staff. If there had been someone there with s/sx of a stroke or MI, I wouldn't have expected her to be so laid back.
Well, see had you included that part of the story, I would have had a totally different perspective. Don't leave stuff out! No I'm not trying to say you made her feel bad. The end result of making her feel bad is that, hopefully, she would change her behavior and use better judgement the next time around Yes, I agree that you "shouldn't" have to but yes there are times when you do have to correct someone.
I have yet to experience an ER visit where I didn't observe staff laughing and joking with each other. Sometimes they are rude in their talking around, about, over, in spite of, the patients, including myself. Nobody wants to feel that they are interrupting something more important with their inconsequential medical complaints. So, if you think this contributed to the matter, then send the letter.
Well, I think you were right to advocate for your son, who wouldn't... But, I think you should have told the triage that you were an LPN when you used the "medical terminology" that was your error, she probably thought you were a nutcase or something. And, you know when you go to the ER, your probably gonna wait. I think that it must drive ED triage insane, you have to understand - people with various levels of medical education come into their realm and give them a DX, and order TX! Hey, its not McDonalds drive thru... can't get an order of fries to go please. :icon_roll
To those asking, what the OP's problem is since when she advocated for her son the triage nurse took him next..my question to you is this..
What if the parent with the child with sternal retractions wasn't a medically trained person..what if it were a lay person..what would have happened then? Most people don't know that how the OP's son presented had the cardinal sign of resp distress. The results might not have been so good.
Now for those of you who say well a layperson wouldn't put the chief complaint as sternal retractions, what would they put..difficulty breathing..not acting right...breathing harder..something along those lines..if the triage nurse didn't immediatly react to seeing sternal retractions..what would make you think she would react to anything a lay person my write down?
I think the OP has a right to be upset. Whether or not she sends the letter is up to her.
And, you know when you go to the ER, your probably gonna wait. I think that it must drive ED triage insane, 
eriksoln, BSN, RN
2,636 Posts
Well, I knew someone who, when upset with something, she'd write a note about it. Never meant to send out the note, just.........wrote one. She'd wait a week, read it and see if she felt the same. A lot of times she was......not as burned up as she acted in the letter. Sometimes she still felt the same.
Thats what I'd do. Wait a week, see if you still feel the T-nurse could have done better. If you still think so, send it. If not, pitch it.