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”.
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
you know, it really shouldn't have to take a tragedy for a lesson to be learned.
my concern is the triage nurse didn't 'seem' to understand the urgency of "sternal retractions".
it was only when mom said he couldn't breathe, is when she stepped up.so yeah, i think maybe something's awry here, and maybe she needs inservicing, or, maybe shouldn't even be in the er.
but if a letter prevents something more emergent in the future, i totally support it.
leslie
Exactly. Regardless of the outcome, whether or not the "what if" actually happened, the fact is that the potential was there, and it seemed to the OP that the triage nurse didn't take her seriously.
No one is perfect 100% of the time. The point of triage is to visualize your patients during the time of assessment. The system certainly isn't perfect either. When the triage nurse needs to see 20 patients it's not always easy to determine the first patient that needs to be seen, furthermore, regarding her laughing and joking with other staff members. I find truely hard to believe that you working LTC never find time to build repore with co-workers even when you have 20 patients waiting for there meds before bed. Additionally, did she state to the patient that she had called ahead of you, "Is it all right if I see this one first." Perhaps she was trying to assess whether or not to take him first. And I can say from experience that is it not fun to tell a patient that you just called that they will need to wait a little longer. Especially if she has been waiting for 20 minutes already. This almost seems like a case of horizontal violence to me. Your child was seen and care for appropriately and the triage nurse listened to you.
Exactly. Regardless of the outcome, whether or not the "what if" actually happened, the fact is that the potential was there, and it seemed to the OP that the triage nurse didn't take her seriously.
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.
When any nurse in the ER sees "Breathing problem" or "Difficulty breathing" they tend to react pretty quickly. So I truely believe that if those had been the chief complaints that service would have been faster. Additionally in those complaints Breathing is in them alerting the nurse instantly.
The only problem I see with it as you are assuming that she was looking to the next patiens "as if to ask permission". In reality, you have no idea why she was looking at that person, she may have been about to tell them they have to wait a while longer. As a nurse, I would not want someone presuming to know what I was thinking before I even get a chance to open my mouth.
That said, if you feel the need to send the letter for closure, you should. If you do choose to send it, I would advice adding a paragraph stating what action you would like them to take. I have learned that anytime you are writing a complaint letter, you need to state exactly, specifically what action you want taken. If you can't think of a specific action that the hospital would reasonably take based upon your letter, why bother sending it?
Your letter includes too many unknowns and what ifs. Keep it to the topic at hand and only the topic at hand. You were happy with the RN and doctors, but not the TN. Keep out the TN looking at the other patient because you have no idea why she looked at her, keep out the what if this and what if that, and how you don't know what anyone else is there for.
Let them know your main reason for writing is that you are concerned this TN didn't seem to realize how important the breathing issue was. Tell them that gave you great pause as a nurse. Let them know the TN did listen to your concerns and did bring your son back, but you decided to follow up because had you been a lay person the outcome might not have been as good as it was.
The only problem I see with it as you are assuming that she was looking to the next patiens "as if to ask permission". In reality, you have no idea why she was looking at that person, she may have been about to tell them they have to wait a while longer. As a nurse, I would not want someone presuming to know what I was thinking before I even get a chance to open my mouth.
That said, if you feel the need to send the letter for closure, you should. If you do choose to send it, I would advice adding a paragraph stating what action you would like them to take. I have learned that anytime you are writing a complaint letter, you need to state exactly, specifically what action you want taken. If you can't think of a specific action that the hospital would reasonably take based upon your letter, why bother sending it?
That was my view of the situation, she just looked at the person, not saying anything. It was only when the other person said, "it's okay, he can go first" did she proceed to assess my son. (I know I didn't put that exactly in the OP.)
I will take your advice and add what I'd like to be done as a follow-up. I really just want this nurse inserviced on two things: 1. that sometimes people DO know what they are talking about when they use medical terms and 2. to make sure she understands the seriousness of sternal retractions.
1. I think if you begin to concern yourself with what the consequences are for her then it is codependent behavior. You are responsible for you and for your behavior. She is responsible for her and her behavior and the consequences, if any of what occurs.
No one here can know what will happen. She may make great calls usually and her manager will say nothing to her or they will take the view that you were pushy or possibly she will get reprimanded. You don't know. I don't know. What we do know is that you wish to voice your opinion about concerns you have. You have presented your concerns in a manner that suggests you are trying to be impartial as you can be. I see no reason to revise your letter.
2. Unless I missed something, you said she didn't peek under his shirt as a part of his assessment? I can't imagine not doing that. Both of my kids have had reactive airway issues and even before school, I would look at their little chests for "sucked in ribs." Further, I imagine I would flunk my checkoff like that and I would feel it justified. If she skipped it, then she didn't complete the assessment. Its just a fact. Am I wrong?
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leslie :-D
11,191 Posts
you know, it really shouldn't have to take a tragedy for a lesson to be learned.
my concern is the triage nurse didn't 'seem' to understand the urgency of "sternal retractions".
it was only when mom said he couldn't breathe, is when she stepped up.
so yeah, i think maybe something's awry here, and maybe she needs inservicing, or, maybe shouldn't even be in the er.
but if a letter prevents something more emergent in the future, i totally support it.
leslie