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”.
Noone is perfect. Your son WAS seen as he needed to be. You can't spend your life saying "what ifs". You have no way of knowing what she was thinking and to presume to know what was in her mind is unreasonable. Do you expect people to read your mind? As another poster said, her look to the other patient could have been one of "im sorry, you are going to have to keep waiting because this little boy is sick". You don't know which one she was thinking or if it was either one of those types of thoughts.
To be demanding that that nurse receive inservicing and retraining based on what ifs is, IMO, outrageous. How would you feel if someone sent a letter like that to your job because of "what ifs"?.
I dont mean to be harsh and if i come across that way, please accept my apology.
Personally, I would just be happy my little one was ok and that she got him back there quickly.
I've been an RN a very long time yet my assessment skills arent perfect. I think you should have written shortness of breath, hypoxia or something else. "what if" you had?
I wouldnt mail the letter. As nurses, knowing how hard our jobs are, if it were me...I wouldnt be trying to cause trouble for another nurse based on 'what ifs'.
Everyone of us could have "what ifs" daily sometimes.
Noone is perfect. Your son WAS seen as he needed to be. You can't spend your life saying "what ifs". You have no way of knowing what she was thinking and to presume to know what was in her mind is unreasonable. Do you expect people to read your mind? As another poster said, her look to the other patient could have been one of "im sorry, you are going to have to keep waiting because this little boy is sick". You don't know which one she was thinking or if it was either one of those types of thoughts.
To be demanding that that nurse receive inservicing and retraining based on what ifs is, IMO, outrageous. How would you feel if someone sent a letter like that to your job because of "what ifs"?.
I dont mean to be harsh and if i come across that way, please accept my apology.
Personally, I would just be happy my little one was ok and that she got him back there quickly.
I've been an RN a very long time yet my assessment skills arent perfect. I think you should have written shortness of breath, hypoxia or something else. "what if" you had?
I wouldnt mail the letter. As nurses, knowing how hard our jobs are, if it were me...I wouldnt be trying to cause trouble for another nurse based on 'what ifs'.
Everyone of us could have "what ifs" daily sometimes.
I'm not trying "to cause trouble" for another nurse. If she didn't take the words sternal retractions seriously, why would she take other words indicative of respiratory distress seriously? That is the main reason I was upset by the whole incident. It was only when I became that "pushy" mom, did she take my son's problem seriously.
As I said in a previous post regarding the nurse looking at the other patient: 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.)
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.
you don't actually know whats going on in the whole ed ..she looked at your son and he was treated appropriately .let it go.as far as the fact that she was laughing or talking is irrelevant.ed are stressful we work as a team .we know how to treat emergencies.we need to communicate to eachother .who are you to judgethe situation simply based on the irrelevance that she was laughing.your son is home fine because ypu spoke up and she listened and got him treated .that should be what matters.
Thank you to everyone for your feedback. I am going to send a letter; albeit, a much shorter one.
To clarify a couple things, I am NOT sending this letter to get another nurse "in trouble" or demand she be retrained. I am sending it because I feel as though my son's condition was not taken seriously.
You don't think she took you seriously when she placed a pulse ox on your son and it wouldn't come above 91% and then proceeded to take your son back into the ER. I perceive that as taking something seriously. Your son got the appropriate treatment, he's fine now, move on.
A respiratory virus. CXR was clean, RSV culture was negative, labs were WNL. Thankfully, after the neb tx and a week of albuterol syrup, he's much better.
I was scared out of my wits though. Any mother of a toddler knows they can get into anything in a matter of seconds, even if they're being watched like a hawk. And this is a child who is deathly allergic to tree nuts. (I don't allow any nuts in the house but you never know what the older ones might drag home from school.)
Thank you to everyone for your feedback. I am going to send a letter; albeit, a much shorter one.
To clarify a couple things, I am NOT sending this letter to get another nurse "in trouble" or demand she be retrained. I am sending it because I feel as though my son's condition was not taken seriously.
obviously it was because your son was taken back immediately and treated and d/c .
My next feeling about the letter is that whoever reads it will look through your son's medical record to see what happened, will see that he was taken back and treated. It will easily be explained away and thrown in the trash.
Many of you are missing the point here. It is the triage nurse's job to make sure patients in jeopardy are seen first. It is her job to know that sternal retractions are an emergency. "What could have happened" is an important consideration, and not just for the OP but for that nurse and the hospital at which she is employed. This triage nurse needs education apparently. Hopefully that will be the outcome of the letter. I agree entirely with sending it.
southernbeegirl, BSN, RN
903 Posts
My opinion only....
Noone is perfect. Your son WAS seen as he needed to be. You can't spend your life saying "what ifs". You have no way of knowing what she was thinking and to presume to know what was in her mind is unreasonable. Do you expect people to read your mind? As another poster said, her look to the other patient could have been one of "im sorry, you are going to have to keep waiting because this little boy is sick". You don't know which one she was thinking or if it was either one of those types of thoughts.
To be demanding that that nurse receive inservicing and retraining based on what ifs is, IMO, outrageous. How would you feel if someone sent a letter like that to your job because of "what ifs"?.
I dont mean to be harsh and if i come across that way, please accept my apology.
Personally, I would just be happy my little one was ok and that she got him back there quickly.
I've been an RN a very long time yet my assessment skills arent perfect. I think you should have written shortness of breath, hypoxia or something else. "what if" you had?
I wouldnt mail the letter. As nurses, knowing how hard our jobs are, if it were me...I wouldnt be trying to cause trouble for another nurse based on 'what ifs'.
Everyone of us could have "what ifs" daily sometimes.