Nurse Tech doing triage........

Katnip, RN · May 11, 2005

We have techs in triage who do vitals before the nurse sees the pt. Also, the experienced ones know if an EKG is needed beforehand. After the nurse seems the patient the tech will do an EKG if necessary and not done before, and sometimes place lines and draw blood.

They don't actually do triage assessments.

dazzle256 · May 11, 2005

We have techs in triage who do vitals before the nurse sees the pt. Also, the experienced ones know if an EKG is needed beforehand. After the nurse seems the patient the tech will do an EKG if necessary and not done before, and sometimes place lines and draw blood.
They don't actually do triage assessments.

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Thank you for your response. Maybe that was the case. My understanding was there was no nurse but could be wrong.

mattsmom81 · May 11, 2005

If that tech is functioning solo, those nurses in ER are fools. They are ultimately responsible and liable for what the tech does (and doesn't) do. And when something goes bad, watch how fast the hospital points that out.

mommatrauma, RN · May 11, 2005

Our techs do name, birthday, cc, and vitals...that's it...the nurse still sees the patient in triage...they just speed up the process...

hal248 · May 12, 2005

To the best of my knowledge you have to be an R.N. to do an inital assessment on a patient. This would precude L.P.N.'s and ER techs. I'm not sure whos rule it is JACHO or NYSDOH but in our E.R. only and R.N. with more than 1 year E.R. experience is allow to work triage.

I'm not an ER nurse but when a tech from my unit floated to the ER she told me she was doing triage. Just curious is this normal? I told the tech that I felt this was out of her scope of practice and for everyones good please don't do this. When I brought this up to the ER manager was told in a nut shell that it was OK.
Is this right?

allnurses Guide · May 15, 2005

When I was researching the EMTALA stuff, the assessment for emergent condition had to be done by an MD or NP (although NPs are a gray area). Nurses can't triage a patient out of the ER setting, to a clinic for instance, so technically they aren't the ones establishing if an "emergent" condition exists. One hospital had specially trained nurses for triage to be able to refer out, instead of everyone who walks in gets an ER doc, and Jahco accepted that because of the special training. EMTALA's big thing is you can't delay care to check on insurance status etc., but you have to assess, and stabalize an emergent condition.

Our hospital requires a nurse to triage, we do all our own vitals etc. I think the liablity of techs traiging, then registration seeing the patient, before a nurse or doc does, would be huge. Our policy is that a nurse must see the patient before registration, and skip regis. if the pt. needs to go straight back.

Just curious mommatrauma, does the nurse talk to the patient while the tech is getting cc & vs, are they already in an ER room? Our folks come into a triage "office", get history etc., supposed to take only 3-5 minutes, then to a waiting room, and when the patient goes back to the ED room, another nurse gets a more complete history.

Nurse Izzy · May 16, 2005

In our ED only RNs were allowed to triage. Techs could do vitals for us if we got slammed, but it was usually easier and faster to do the vitals while asking questions. I'm not sure what the experience level had to be - I wasn't put into triage until 6mos in our ED. If a patient waited in the lobby for more than 2 hours they had to be re-checked, inlcuding a full set of vitals. Again, techs could do the vitals. We had a few techs who'd been around for so long that they could ask questions that I hadn't thought of, as well, so there is a fine line to allow for experience.

That said, I was under the impression that our state's BON required a nurse, preferably an RN to triage, that it was beyond the scope of a tech.

mommatrauma, RN · May 16, 2005

When I was researching the EMTALA stuff, the assessment for emergent condition had to be done by an MD or NP (although NPs are a gray area). Nurses can't triage a patient out of the ER setting, to a clinic for instance, so technically they aren't the ones establishing if an "emergent" condition exists. One hospital had specially trained nurses for triage to be able to refer out, instead of everyone who walks in gets an ER doc, and Jahco accepted that because of the special training. EMTALA's big thing is you can't delay care to check on insurance status etc., but you have to assess, and stabalize an emergent condition.
Our hospital requires a nurse to triage, we do all our own vitals etc. I think the liablity of techs traiging, then registration seeing the patient, before a nurse or doc does, would be huge. Our policy is that a nurse must see the patient before registration, and skip regis. if the pt. needs to go straight back.
Just curious mommatrauma, does the nurse talk to the patient while the tech is getting cc & vs, are they already in an ER room? Our folks come into a triage "office", get history etc., supposed to take only 3-5 minutes, then to a waiting room, and when the patient goes back to the ED room, another nurse gets a more complete history.

You walk into our ER...you meet our security guard..he directs you to the triage waiting area...which consists of approx 25 chairs set up in 4 rows...there are then 2 cubicles in front of where these patients sit...the waiting area and nurse are simply separated by a half wall and a curtain should you chose to pull it closed for privacy. The cubicles themselves where the nurses or nurse and tech sit are next to each other but separated by a wall. If the other person says something a little louder than a conversational voice it can be heard in the next cubicle...without all the fanfare let me see if i can draw you a picture of how it looks...keep in mind...I'm not an artist!!!LOL

HHHHHHHHHHHH

main waiting room}HHHHHHHHHHHH

HHHHHHHHHHHH

when you first walk in you see security desk-> ]

hhhhhh

^

triage waiting room

+++++

nurse sits here [] nurse/tech sits here

...We usually have 2 nurses in triage for approx 20 out of 24 hours a day, in which case, we would do all of our own vital signs and full triage...so the tech thing is not usually an issue...If we do have a tech out there say if we have more than 2 traumas and they need another hand...they would pull our second triage nurse and send out a tech...so while I am triaging a patient the tech will take the next patient and start doing vital signs and their name...our triage system is computerized...so as soon as they are in the system I can see what their chief complaint is on my screen simply by hitting a button...If the tech has any concerns AT ALL they can simply yell to me. I can eyeball every patient that sits down in the triage waiting area because they all sit right in front of me...The whole tech process with entering info and VS really takes less than 5 minutes...and then they are in my chair, if not they sit right in the triage waiting room again right in front of me until I am ready for them...The techs in NO WAY level the patient, that is still the nurses responsibility...once they are completely done with the triage process, if they are not brought right back to the treatment area they then go to the main waiting area where they wait to be taken back to the treatment area...If registration gets to them first they will be registered, however the reg process stops where it is if they get called back to the treatment area and it is finished at some point before they leave. They also do not go to registration until they are fully done their triage process...so they definitely are seen by the nurse before that happens...As for the whole process taking 5-6 minutes...it still happens that way...for the most part...however not all nurses as proficient then others at getting quick story and moving on...we have some nurses that could jam up triage with only 3 patients...then there is others who can triage 12 an hour and never bat an eye. If I am faster than the tech I usually have the skip ahead to the next patient so nothing gets slowed down. I won't sit and wait for the tech to finish the patient and not do anything. I may move on to the next patient, or just go over and ask the info while the tech is finishing up...so its basically just to move things along, keep a steady flow...We see upwards of 225-250 a day...The fact that the vital signs are already done for me allows me to ask questions quicker and type faster and gives me less typing to do without having mess with other equipment...It works for us...Hope that helps without making it more confusing...

allnurses Guide · May 16, 2005

Yeah, it makes sense. Sounds a lot like ours, only we have a glass wall and desk to sit behind (bullet proof no less). Security has to be paged, but since we're behind the glass that's usually okay. We do registration the same way. Haven't started computerized charting yet though, supposed to happen in the next 6 months or so. From 11P to 7A its only one nurse, to log everyone in and triage and hang the charts. Really like the locked doors at that point!

Thanks for the answer :balloons:

mommatrauma, RN · May 16, 2005

Yeah, it makes sense. Sounds a lot like ours, only we have a glass wall and desk to sit behind (bullet proof no less). Security has to be paged, but since we're behind the glass that's usually okay. We do registration the same way. Haven't started computerized charting yet though, supposed to happen in the next 6 months or so. From 11P to 7A its only one nurse, to log everyone in and triage and hang the charts. Really like the locked doors at that point!
Thanks for the answer :balloons:

Our registration people sit behind bullet proof glass, because they have money because of co-pays and what not so it posed a higher risk....we only do computerized charting in triage, we are slated to start total computerized charting in September...I can't wait, I can type way faster than I write...so I look forward to starting it, although I'm not sure what we are going to use yet...It hasn't been revealed.