MisfonzRN

So depressing....

CONGRATS! Hopefully you will enjoy your new position. I am also new to telephone triage and have been doing it almost a year now. My advice....find a really good experienced RN that you can shadow and spend as much time with them as you are allowed. Observe as many different calls as you can. Each one is different! Secondly, try not to diagnose. Try to listen to all of the patient's complaints, pick out the ones that are the most concerning and focus on those. It's easy to slip into a protocol based on some symptoms and end up in the wrong place. I once had a patient who called with urinary symptoms....burning, frequency, inability to empty out...UTI, right? The doctor sent her to the hospital for further testing because he suspected cauda equina syndrome. I had never even heard of that! It can be very serious. Thirdly, think of yourself as the air traffic controller. You screen the patient and decide where they need to land. Have fun and welcome to Telephone Triage! Its the wave of the future!

I am an RN in a family medicine practice. I have been here nearly a year after 20 years in ICU. This office did not have an RN previous to me. I am having difficulty getting appropriate calls routed to me for triage. I'm wondering if anyone has a "Red Flag List" that can be used for reference by front office staff. Basically this would be a guide as to which calls should be routed for triage and which should be scheduled for an appointment. For example... all chest pain calls, all weakness on one side of the body, all seizure activity, all trauma... Does anyone use a list like this that would be helpful in guiding the folks who answer the phone as to who to route to triage? Thank you!

Just last Friday, my husband's 90 year old grandfather passed away. He was completely alert and oriented right up to the end of his fight with cancer. He died on Friday, July 13th at 12:05am. He was a veteran and was shot in the knee during WWII on Friday the 13th. When he was in the ICU last month, he was in room 13. The hospice facility in which he died was exactly 13 miles from his home. Here's the clincher: His wife died on Friday the 13th, 13 YEARS AGO!! Guess what his favorite number was.... Yesterday I was out on my deck reading when my almost three year-old son started talking to someone in the corner of the deck by the house. He kept on having a conversation with this person so I finally asked him who he was talking to. "Great Grandpa" was his response. "He's right over there." My husband told him to tell him he said hi, so he did. He said "Daddy say hi" and then he giggled at the unheard response he got. Later I heard him talking to himself on his toy phone and he said, "Great Grandpa was in the hospital, and then he died and then he came here." I asked him if Great Grandpa was still around and he said, "He's not here now."

I always tell people I was a Nursing Home Administrator in my previous life. I went into it thinking I could change the world and really make a difference in the resident's lives. As it turned out, it's all about business. One day in the shower it just hit me like a ton of bricks (I call it Divine intervention) that I should go to nursing school. It was a huge undertaking, especially since, at the time, my husband was ready to have children. I went to school and was, frankly, bored. That was until my last class, Critical Care. From that time on I knew exactly where I belonged, at the bedside of the critically ill or dying patient. That's where you can really make a difference, at the bedside. I really wish I would have started out in nursing years ago.

I now have an irrational fear of mylar balloons.

I work in a 14 bed CCU in Ohio and we have noticed a drastic changed in our patient population in the last 3-5 years. When I started in this unit in 1999, we got a lot of patients with MI's, Unstable angina, post cath lab intervention patients, new onset Afib, and patients waiting to go for a CABG. Now, our population is much sicker and seems to belong in a medical ICU. We get the DKA's, overdoses, new CVA's, a lot of ETOH, sepsis, COPD and a lot of other bizarre stuff. We never get Unstable angina patients anymore, they go to stepdown and a lot of the time our patients don't even have a cardiac diagnosis. I was wondering if other CCU nurses noticed the same thing in their units. I realize that times have changed, but we are getting frustrated with this new, difficult population. Any thoughts?

I give a short medical history and history of this hospital stay. I then talk about events that happened in the last 24 hours. I go over IV lines and drips. I then go through the assessment and talk about anything abnormal. I also try and mention abnormal labs and what I did about them. I work in a CCU and if the patient is particularly critical or involved (ie lots of equipment, prisma dialysis, drips, balloon pump, etc), we often give report at the bedside so we can go over everything.

I have a personal one that just happened recently. The story starts 25 years ago when my grandmother died. To make a long story short, my parents and I had gone to pick her up for Christmas and found her dead in her apartment. My mom and I were talking on the way home and both shared that we had had dreams the night before in which grandma had said goodbye. (Incidentally, her best friend, who was in the hospital at the time, died within an hour of when Grandma died.) Fast forward to December of 2005. I had a dream on December 15th in which my grandma appeared and said hello to me. In my dream she gave me a hug and said she was proud of me. I mentioned this to my mom the next day and she told me that it was the 25th anniversary of my grandma's death. My husband says I must have known, but I had no idea of the date of my Grandmother's death. My other grandma visits me, too, but that's another story...