RN experience prior to ER triage?

bigreddog1934 · Oct 19, 2009

In my last job it was about two years before they started inching you into triage. Then you would be part of two nurses for a bit until you were the sole triage RN. There was also a class on triage you took before heading out there.

RNBelle · Oct 19, 2009

So putting a new grad in the triage/charge role just after orienting for 3 months is not appropriate? (I am being sarcastic) I work L&D but a friend is in the ER.

robinzkj · Oct 19, 2009

Where I work you must have 6 mos ER experience before you can go to triage. No rules here for charge but I've been in charge and have 18 mos nursing experience, 9 of which in ED.

Editorial Team / Moderator · Oct 19, 2009

For us it's 6 months of ED experience before you get out there at all, and they prefer a year, plus our facility's ESI triage class. They also prefer an RN with his/her CEN too, but that doesn't happen often in my facility.

EmergencyNrse · Oct 19, 2009

A good facility will require you to have some experience plus have a preceptor program to ease you into the role.

That being said I know of MANY hospitals that throw the new grads out front with no experience and a triage algorithm to dictate acuity. So if you're a new grad in the hot seat.....Gooooood luuuuck!

These centers set the tone for the entire department because you get patients mis-categorized all the time. Everyone is frustrated and it becomes dangerous.

Sending the patient to FastTrack or Quick-Care with just "swollen feet" that is.... um, status-post 5 vessel CABG day 3 is inappropriate.

djaychris · Oct 19, 2009

ED triage is not something to take lightly. It also depends on what kind of triage system your ED has. In the first ED I ever worked in, triage was run by 1 nurse. That nurse had to assess the patient, decide whether they were appropriate for the ED or quick care, then decide whether they could wait, or whether they needed rushed back. The triage location was located outside the ED, and the RN was on their own. During busy days in this ED, I sometimes saw waiting times as long as 8 hours. On days like this, it was terrifying to be the triage nurse. If you misdiagnosed a patient in triage, bad things could happen in the waiting room (and they did). If you ran every patient back because you were unsure of yourself, you would jam the ED and anger the charge nurse. That ED required 1-2 years experience before training a nurse for triage. The ED I currently work in has a "no wait" policy. All patients are brought back immediately, regardless of complaint or ED volume. In a situation like this, much of the responsibility of triage is lifted from the RN's shoulders. If you are considering working in triage, make sure that department gives you enough training. Triage is a unique environment for the RN. Mistakes made in triage (under extreme circumstances) can potentially cost a patient their life.

PostOpPrincess, BSN, RN · Oct 19, 2009

3 months?

That's scary.

BrnEyedGirl, BSN, MSN, RN, APRN · Oct 19, 2009

Check the ENA website,...but I believe they recommend 1yr of ER experience and the triage class before working triage,...that's the policy where I work/

LilgirlRN, ADN, RN · Oct 20, 2009

On another thread about triage someone wrote about the charge nurse and the triage nurse often have the most experience. I've been an RN for 22 years. It makes me quick and my experience allows all those who work "in the back" to know that if I say it's an emergency, IT IS!

Now back to the question, here it's a year before you can triage. Please, any newbies reading this, don't take anny offense.... What I know about nursing I learned after I got out of school. School and being a nurse, a working nurse isn't the same thing. New grads should never be put in triage in my opinion because they just don't have the experience and it's very stressful. Stress someone out enough and not give them enough support and guess what? They'll quit on ya and go somewhere else.

MikeyBSN · Oct 21, 2009

Although I agree that there is probably some minimum experience requirement for triage, I would put the emphasis on competence over experience. I have worked with some very competent nurses who have only been RNs for one or two years (but most have medical backgrounds or where paramedics). At the same time, I have worked with nurses who have been RNs far longer than me and let's just say that triage is obviously not their forte'. My facility actually has a test you need to take before you're allowed to be in triage.

MikeyBSN · Oct 21, 2009

A good facility will require you to have some experience plus have a preceptor program to ease you into the role.
That being said I know of MANY hospitals that throw the new grads out front with no experience and a triage algorithm to dictate acuity. So if you're a new grad in the hot seat.....Gooooood luuuuck!
These centers set the tone for the entire department because you get patients mis-categorized all the time. Everyone is frustrated and it becomes dangerous.
Sending the patient to FastTrack or Quick-Care with just "swollen feet" that is.... um, status-post 5 vessel CABG day 3 is inappropriate.

I just had a patient the other day who had lower extremity edema, chest pain, nausea and hypertension. Although she was relatively young, she had been traveling a lot over the past few months. The triage nurse, who probably has about 15 years on me in nursing, triaged her as a "5" and sent her to fast track! Of course, FT booted her once they examined her and sent her to the main ER. I think she was an RN or resident or something because she knew what she was talking about and she was rightfully very upset.

In four years I have only "written up" another nurse once, and the situation stemmed from a grossly inappropriate triage. It involved a young patient with a serious medical condition who was hemodynamically unstable. She was triaged as a "4" and waited five hours before any type of medical intervention.