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”.
I think "sternal retractions" is too vague, and does not give enough clues about your son's condition. Were they suprasternal or substernal retractions? What was his respiratory rate? Any stridor? What about his color?
"Sternal retractions" in and of itself does not give a complete picture of the patient situation.
I think "sternal retractions" is too vague, and does not give enough clues about your son's condition. Were they suprasternal or substernal retractions? What was his respiratory rate? Any stridor? What about his color?
"Sternal retractions" in and of itself does not give a complete picture of the patient situation.
The retractions were complete; they included everything from collarbone to belly. He was literally using all of his muscles to breathe. Resp rate was 38. Color was good. Audible wheezes but no stridor.
As I stated in the letter, what mother thinks coherently when her child is ill?
Okay, so you might want to include that he had suprasternal, intercostal, and substernal retractions with audible wheezes and a RR of 38. I'd leave out a bunch of the stuff you wrote though. There are a lot of irrelevant details, IMO. When you leave out the irrelevant details, the story, in a nutshell, is that you had to point out to the triage nurse that your three year old child was in respiratory distress. You don't need to elaborate on that any further. It speaks for itself.
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. however, i was greatly disappointed in the triage nurse. i am sorry to say i do not remember her name.
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, on which i had written "sternal retractions", 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. he had suprasternal, intercostal, and substernal retractions with audible wheezes, and a respiratory rate of 38.
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.
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 am very concerned when i think about what could have happened had i not spoken up.
Thank you. I tend to get things jumbled up - a product of my mind working to fast to process everything it wants to get out. LOL (You should hear me talk - my grandma's favorite thing to say, was "shut up, slow down, and say it again). Sorry, I know it's off-topic.
And referring to an earlier post, it's not a Press Gainey form that is sent out; it's a "satisfaction survey" or something along those lines that they send to every patient. I plan on sending the letter back with that survey.
Yea, I do believe it is a Press Gainey, they are the firm that runs/compiles the survey stuff.
Our facility sends out satisfaction surveys that have nothing to do with PG. They're just a little card that the patient fills out and puts in the mail, no postage necessary if mailed in the US. They go to the hospital administrator.
I didn't read all of the posts, but I agree with writing your letter. ER's need good people to front their triage areas. While not a pediatric ER specialist, I take great care in triaging children with breathing difficulties because children compensate then DIE! Adults go on forever before going into any type of failure, the window for kids is narrow and lowers the younger they are. Any pulse ox below 95% on room air in a kid is an indicator of trouble, sternal retractions, along with nasal flaring and many other subtle signs is a sure sign of problems. Many nurses do not undress kids to see where they stand and that is a huge mistake, they are not little adults!
While we all make mistakes, there is nothing scarier than seeing a kid go into respiratory failure in a waiting room or shortly after room time because the parents waited too long to come. WE are supposed to be the ones to "save" their little ones, that involves knowing-that ER and it's management need a refresher course. I think the letter remarks on the problem nicely, yet gives kudos for action when it was taken. Next time it could be a kid with croup, or asthma and they may not make it!
My opinion: let it go. I would assume that you being a nurse would make you more - not less - understanding of the situation. You put retractions and that is how the nurse initially assessed it, as is their job. When you explained the urgency to her, she gave your son priority and handled the situation to the extent she was supposed to and he is now okay. What use is holding onto the anger or getting back at the person who maybe was just having a bad day? Then again I am sure you feel stronger it being your son. But my opinion is just let it go.
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Virgo_RN, BSN, RN
3,543 Posts
I think "sternal retractions" is too vague, and does not give enough clues about your son's condition. Were they suprasternal or substernal retractions? What was his respiratory rate? Any stridor? What about his color?
"Sternal retractions" in and of itself does not give a complete picture of the patient situation.