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 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
There are times though when I hate pulling rank and throwing around my title. I've done it a couple of times. When my grandfather who was s/p CABG and at a rehab facility and he was hypotensive, delirious because he was septic and his wound where they harvested the veins was red/hot. He ended up having to go back to the hospital, have his chest cracked open again, intubated, trached and vented. Staff was fired at the facility due to their lack of judgement..."Oh, that BP is normal (75/40), it's ok. His temp is fine.." NO A TEMP of 39.0 IS NOT FINE.
If I'm reading it correctly it seems the OPs main complaint is that the triage nurse looked to another patient for what?.... we will never know. Maybe it was because she happened to be standing in front of the next patient in line and needed to do something to acknowledge the other patient rather than just walk away and start treating your son. Just being devils advocate but imo it did turn out as it should have thank goodness so the what-ifs are irrelevant because they didn't happen and she did exactly what you expected of her. Other than not immediately dropping the next person waiting in line but really is that enough to warrant a written complaint that goes in another nurses file? Personally I don't think so and since you asked for opinions I hope you aren't offended by differeing ones. Again thank goodness that your baby is fine and that you were there to be his advocate because I believe an advocate is needed by every single hospital patient.
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.
Thank you. That's exactly why I asked for opinions.
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.
This. This is exactly why I'm so upset about it. And to the person who said I should have idenitified myself as an LPN: I was wearing scrubs, it wasn't my main concern that the triage nurse know my title, and I've found that RN's in the ER tend not to take you as seriously when you say "oh, I'm a nurse" or "oh, I'm an LPN" (not ALL ER's, but this particular one).
I would send the letter, if nothing else to remind staff that patients waiting to be triaged get VERY miffed (and RIGHTLY so) to see everyone laughing and joking around....irregardless why they are there. And that triage nurses are the first medical person a patient sees--and need to act accordingly in a very few minutes of time. If nothing else a learning experience.
I also think just as a personal aside, that in a similar circumstance, rescue could have been called to bring a child to the ED. If the child was experiencing sternal retractions, and have difficulty breathing they could have at least started him on some O2. I often think that if a parent drives a child into the ED and says they are having- in your case sternal retractions--others-difficulty breathing- it doesn't seem as "red flag" in a lot of instances. Mom mode says grab em and go--but thank God you got your child there and something difficult did not happen as you were driving the child there.
I've also ripped ER (intake) for my mom, she was crashing... long story, and I wasn't a nursing student then. Even made the poor girl cry. I'd still do the same now (I am amazed at how mean I can get). My point is, I think if there is what seems to be complacency it comes from what I mentioned in my prior post. I can understand what they deal with daily... everybody's an MD these days. However, even though I can see it from their side too, doesn't mean I won't ever make somebody cry again... :angryfire look out.
If I'm reading it correctly it seems the OPs main complaint is that the triage nurse looked to another patient for what?.... we will never know. Maybe it was because she happened to be standing in front of the next patient in line and needed to do something to acknowledge the other patient rather than just walk away and start treating your son. Just being devils advocate but imo it did turn out as it should have thank goodness so the what-ifs are irrelevant because they didn't happen and she did exactly what you expected of her. Other than not immediately dropping the next person waiting in line but really is that enough to warrant a written complaint that goes in another nurses file? Personally I don't think so and since you asked for opinions I hope you aren't offended by differeing ones. Again thank goodness that your baby is fine and that you were there to be his advocate because I believe an advocate is needed by every single hospital patient.
The nurse had called the next person's name; she was not with them yet. My complaint is that she did not take the complaint seriously and when I called her on it, she looked to the next name on her list as if asking permission. This person was not being triaged, they were still sitting in the waiting room.
And, no, I'm not offended by differing opinions. The reason I asked for them is that I want it known that this nurse maybe needs a refresher on triaging but I wanted to make sure it came off professional and not just sounding like an irate parent.
I would send the letter, if nothing else to remind staff that patients waiting to be triaged get VERY miffed (and RIGHTLY so) to see everyone laughing and joking around....irregardless why they are there. And that triage nurses are the first medical person a patient sees--and need to act accordingly in a very few minutes of time. If nothing else a learning experience.
I also think just as a personal aside, that in a similar circumstance, rescue could have been called to bring a child to the ED. If the child was experiencing sternal retractions, and have difficulty breathing they could have at least started him on some O2. I often think that if a parent drives a child into the ED and says they are having- in your case sternal retractions--others-difficulty breathing- it doesn't seem as "red flag" in a lot of instances. Mom mode says grab em and go--but thank God you got your child there and something difficult did not happen as you were driving the child there.
If we lived anywhere besides where we do, I would have called 911. We literally live a couple blocks from the hospital, in a not-busy part of town. I got my son to the ER in probably 2-3 minutes, where it would have benn 8-10 minutes to wait on EMT's. And again, that is my pain point, that the triage nurse did not take the complaint seriously.
she looked to the next name on her list as if asking permission. This person was not being triaged, they were still sitting in the waiting room.
And, no, I'm not offended by differing opinions. The reason I asked for them is that I want it known that this nurse maybe needs a refresher on triaging but I wanted to make sure it came off professional and not just sounding like an irate parent.
But the as if is my big issue here. Personally from what you have written I don't think it sounds like she needs a refresher on triaging because she looked at another person as if asking for permission. Definitely write the letter if you feel its worth it but if you work at this facility I'd give that some thought also before making a written complaint on someone based on as if. Just my
But the as if is my big issue here. Personally from what you have written I don't think it sounds like she needs a refresher on triaging because she looked at another person as if asking for permission. Definitely write the letter if you feel its worth it but if you work at this facility I'd give that some thought also before making a written complaint on someone based on as if. Just my
I agree. To me, "what if" is irrelevant because they didn't happen. What did happen was that her son was taken back and treated. No "what if" occured. The triage nurse could have also said to the patient "Sorry, this patient is having difficulty breathing, I will take them back and will be back to assess you." But you can woulda, coulda, shoulda it all day long. The fact of the matter is the "what if" didn't occur.
As a mother of an asthmatic I knew what sternal retractions were before I was a nurse, and I probably would have used the term because I was taught to look for them and consider them dangerous. I seem to remember whenever I called and reported this or arrived with it, it was like a red flag to the medical personnel that my son was in need of immediate attention. (From what I remember, that seems like ages ago; okay it was) A kid with sternal retractions is really scary to see as you can usually see terror in their faces. I am glad your son is okay.
I am mixed on the letter. She shouldn't have missed that and obviously maybe some inservicing/training was needed. But judging by her response I like to think she realized her error and wouldn't respond the same way again. I know as a nurse that I will never make the same mistake twice, its a powerful lesson to have a near miss and nurses generally beat themselves up more then any letter in any file would, Just think your experience may save her and some other tot in the future.
Since it has been a week and you are still very upset perhaps sending the letter will provide closure for you. Okay just call me windy.
1. Lay people can know what sternal retractions are if they have a sick kid.
2. I understand it is not your job to educate her, but you did and I bet it sticks.
3. You have a right to complain if you feel it warranted.
RN1982
3,362 Posts
There are times though when I hate pulling rank and throwing around my title. I've done it a couple of times. When my grandfather who was s/p CABG and at a rehab facility and he was hypotensive, delirious because he was septic and his wound where they harvested the veins was red/hot. He ended up having to go back to the hospital, have his chest cracked open again, intubated, trached and vented. Staff was fired at the facility due to their lack of judgement..."Oh, that BP is normal (75/40), it's ok. His temp is fine.." NO A TEMP of 39.0 IS NOT FINE.