new to triage

Hello!

I have been working at an ER an hour from where I live that generally sees about 300 pts a day. I recently took a job 5 minutes from my house in a local ER that sees about 45-50 pts a day. Here I will be doing triage from 3pto 11p. This ER has never had a triage nurse before, so I will have the chance to set standards and really get this going. Does anyone have any suggestions?At my current job we triage our own pts after 11p, but I've never been the actual "triage" nurse before. Any suggestions for this new triage nurse?

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Take a triage course and emergency nursing pediatrics course. It will be beneficial to you.

The hours for you are our busiest in ER.

Good luck.

Good luck! Triage is the one area that I have found that most nurses hate. Though, I do work with a few nurses that love triage. I hate getting 3 chest pain pts a once, no beds for any of them, then having a premie baby come in with fever 103, then acute asthma attack and pts yelling at you.... you get the idea. I love to critically think, but sometimes my brain gets cramped in triage. But I work in an ER that sees ~600 pts/day. With only 45-50 pts a day though, it shouldn't be too bad.

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Take a triage course and emergency nursing pediatrics course. It will be beneficial to you.

The hours for you are our busiest in ER.

Good luck.

I am a new ER nurse and we do our own triage also...do you have any suggestions on triage courses to take?? I feel I really need some help in this area....

thanks....K

I would suggest the nationally recognized 5 tier triage class system and there should be recourses galore to research. When we started it a couple years ago we had algorithms posted in triage and in the break room for nurses to look at. My biggest issue with triage is the lack of consistency when I'm charge I know some nurses I don't want out in triage because everyone will be "2's" or "3's" and they need to get "right back".

Do you have treatment guidelines for apap/motrin for kids fever's etc...someone to help with urine dips from triage...all things that speed up the throughput?

The ESI 5-level system is a recognized standard.

http://www.ahrq.gov/research/esi/

Go to the ENA website, they usually have a list of courses in your area that would be helpful to you. We use the 5 levels too although we use T sheets to chart on and they only offer 4 levels with level 1 being the most acute. With not many people to triage you should be able to perfect your skills with little anxiety. You didn't say how many beds your ER has though. If you only have 5 beds in the whole place and you see the number of patients you do then that would be a terrible day because you wouldn't have anywhere to put the patients. Chest pain always comes first here but we also use common sense, if the patient is 10 years old with chest pain they aren't given the same priority as say a 50 year old. Sometimes the squeaky wheel gets in here before others do because they upset the whole waiting room if I don't go ahead and pull them into triage. Someone acting like they are about to croak when you know they aren't (one of the frequent flyers) will make other patients act as if they aren't even sick. I've had people with chest pain and known heart disease tell me to take someone before them based on the way the other patient was behaving. One of our computer programs will show the patient's name when they register and will show how many visits they've had and what they complained of then, I find it very valuable. If a patient has been here 5 times in the last week with chest pain and has even been admitted and worked up for same then I can take someone else before them. Remember that children can compensate for a while and then crash rapidly. One of the best classes I ever took was on pediatric assesment from ENA, find a class and take it! I keep a supply of collars out here in triage, I work in a semi-rural hospital, you never know what kind of injury will come through the front door. I usually have a tech too, if we're extremely busy and have no empty rooms, I'll order Xrays and have the tech transprt the patient there and back to the waiting room. We also swab throats, do UA's etc. I treat fever because we have a standing protocol for fever in children.

Don't take it personally when other nurses tell you that they hate you

Set up your triage system based on the ESI 5 level system. It is a nationally recognized standard and helps to sort things out for you. Check the ENA website for all sorts of resources. I know they even have workbooks that your hospital can purchase to help train future staff. Good luck!

Good luck! Triage is the one area that I have found that most nurses hate. Though, I do work with a few nurses that love triage. I hate getting 3 chest pain pts a once, no beds for any of them, then having a premie baby come in with fever 103, then acute asthma attack and pts yelling at you.... you get the idea. I love to critically think, but sometimes my brain gets cramped in triage. But I work in an ER that sees ~600 pts/day. With only 45-50 pts a day though, it shouldn't be too bad.

wow 600 patients come through triage a day.....(How many beds do you have in your ER?)

Take the "Triage First" course if you can.

Err on the side of caution.

Have your facility implement standing orders if not already done.

Don't take crap from the folks in the back about your decisions.