sacrifical lamb=triage nurse

[Uptoherern]

Another death in the ER waiting room. The article doesn't explain the situation very well, but it seems to me that the hospital is telling the reporter, Look! We DID do something! See? We placed the NURSE on administrative leave!

Now I know I may be seeing something that isn't there, but this is how it appears to me. Give us more to do with less, and when something goes wrong because of it, well, blame us!

GRRRR

http://www.latimes.com/news/local/la-me-kingharbor16may16,1,2218046.story?ctrack=1&cset=true

[TazziRN, RN]

Oooohhhhhhhh......King Drew.....yeah, they've got a really bad rep. I know someone who worked there as a traveller, and the travellers were carpooled to and from the area by hospital van for their safety.

[Altra, BSN, RN]

Oooohhhhhhhh......King Drew.....yeah, they've got a really bad rep. I know someone who worked there as a traveller, and the travellers were carpooled to and from the area by hospital van for their safety.

The hospital has major problems on all levels ... but "issues" like the one noted above speak about the neighborhood, not the hospital itself.

--MLOS, who also works in a hospital in an area where you don't walk by yourself to the off-campus parking lot, ever.

[CritterLover, BSN, RN]

when i read the article it said the patient had been seen several times in the past week, and in fact had just been released when she complained of increased pain, and started writhing around on the floor, probably with impressive sound effects.

if i had been the triage nurse, and if i knew she had been seen multiple times by multiple docs in the last week, and had a history of drug abuse, she would have been retriaged as a 4 and encouraged to expect a long wait. wrong call, obviously, but she had just been seen.

given 5 or 6 people that are complaining of incredible pain and haven't even been seen once vrs someone who just got worked up, and discharged i'll get everyone seen once before starting at the end of the line again. if she was cussing or creating a disturbance, yep, i'd call the police.

it's a horrible tragedy, but i can absolutely see it happening with the most attentive and sympathetic triage nurse.

agreed.

i thought that myself when i first read the article.

i also wondered if she had asked to check back in when she was saying how much she was hurting. if she hadn't, she might not even have been seen by a nurse again.

angie, i also wondered about how much of a work-up she had received. truthfully, if she had been there three times in the span of a few days, and had received the whole work-up once, i doubt she received it again. but i did wonder if she got a detailed work up even once.

none of this may have been under the domain of the triage nurse. if the physician didn't work her up adequately, or if she asked to be seen again, but didn't get re-registered, there isn't much the triage nurse can do.

idealy, the triage nurse would be able to keep an eye on the waiting room. but in reality, when you are trying to get everyone triaged for the first time, it is tough to keep an eye on what is going on out in the waiting room.

it is really tough to get good information from the media reports. they confuse things that may seem to be "minor" but really are significant from a medical perspecive.

[canoehead, BSN, RN]

The hardest issue for me is when someone is writhing around on the floor and screaming my knee jerk reaction is "drama queen." Especially if they have the poor-hygiene-stinky-poor-me aura.

Yep, I admit it.

I have to conciously set that aside and look for the objective signs, but pain really has precious few objective signs.

Putting pain aside, I really take people seriously if they are less emotional when they say that something is really wrong, as opposed to the 3 family members that try to convince you the patient has never felt this bad before in their lives, and the patient can't/won't assist with the assessment at all. You have to be pretty near unconcious to not be able to answer yes/no, or stop screaming long enough to tell me what's wrong. That's a sure sign of "not sick" for me, but they still get brough back, cause they're scaring away all the wildlife for miles around.

[wildcats]

The hardest issue for me is when someone is writhing around on the floor and screaming my knee jerk reaction is "drama queen." Especially if they have the poor-hygiene-stinky-poor-me aura.

Yep, I admit it.

I have to conciously set that aside and look for the objective signs, but pain really has precious few objective signs.

Putting pain aside, I really take people seriously if they are less emotional when they say that something is really wrong, as opposed to the 3 family members that try to convince you the patient has never felt this bad before in their lives, and the patient can't/won't assist with the assessment at all. You have to be pretty near unconcious to not be able to answer yes/no, or stop screaming long enough to tell me what's wrong. That's a sure sign of "not sick" for me, but they still get brough back, cause they're scaring away all the wildlife for miles around.

I don't want to hijack this thread but your post reminded of what happened to my fiance a while back.

He came home from work ... greasy, dirty, smelly, etc. complaining of a stomach ache. As the evening went on his pain was getting worse and he was vomiting green stuff. This had happened before a few years ago when he had a bowel obstruction so I listened for bowel sounds ... none.

By the time I got him to the ER he was screaming in pain and hyperventilating because he was panicky and scared. I had to lift him out of the car and take him in the ER in a WC.

He's in triage still screaming and vomiting and barely able to answer the yes or no questions so I help answer the nurses questions. She got his vitals, slightly elevated BP but otherwise normal. I explain about his past bowel obstuction (he has scar tissue that built up from a previous surgery). The nurse asks what they did for the last obstruction and I told her that they put a tube down to decompress. She then begins to tell me that it couldn't have been an obstuction because they didn't do surgery. So, I guess the docs a few years ago and the CT were wrong?

Anyway, he's still screaming and vomiting and the nurse looks at me and says "He does this often doesn't he?" I said no he really never complains about anything so this must be really painful. She says well all our beds are full and there is nothing I can do so you will have to wait. I know the beds were full, the ER was packed.

She never listened to bowel sounds either ... I honestly don't know if thats part of a triage assessment.

Anyway, we wait about 20 minutes and during that time two "walkie talkies" were taken back. I was livid. He is still in pain, vomiting, etc. I go back to the nurse. "Sorry no beds."

I have had enough and I take him back to the car and lift him back in (lucky he's only 140 lbs. lol) and we go the other ER in town which is full also. Triage takes him back and decides ... yes, somethings wrong here. They put him in a bed behind triage until they get a bed for him 5 mins. later. Doc immediately comes in and orders pain meds and nausea meds and a CT scan.

Scan shows a bowel obstuction ... he was admitted to hospital for 4 days to decompress.

Sorry so long. I don't know why the first triage nurse acted as she did ... was it because she thought he was faking or a drug seeker? Or was she just overwhelmed with work? Honestly, the first hospital we went to is a very large medical center and there is no way that I would have been able to handle the amount of patients that triage nurse was responsible for.

Anyway, I know its aggravating and ERs see alot of faking and drug seeking, but just because someone smells and screams doesn't mean they aren't sick.

(I want to add that tone of a post is hard to tell so I am not putting anyone here down for their beliefs or actions. Just telling a story in a nice way ... or trying to.)

[etceducator]

I feel your pain! I am the clinical nurse educator for an emergency department. Sounds like triage is pretty much the same everywhere. I am working on a triage education program to try and develop our triage nurses. However, it is a difficult task. Some days, no matter how much education you have, it can't help triage 20 patients that present in 5 minutes of each other. Do you all have to have a certain amount of experience/ classes/ or qualifications to do triage? If so, what are your requirements? Do you all have a medical person that first greets the patient/ documents a chief complaint? Thanks!

[canoehead, BSN, RN]

wildcats

Thanks for the reply.

What I meant was, I see my difficulty with that type of patient as something negative, and I have to conciously put my gut reaction aside when they come in. I also find it hard when visitors answer all the questions because I need to assess the patient in so many different ways (mental status, understanding of their illness, severity of symptoms) and 90% of the time patients add a lot more to the assessment. At the same time I can easily see myself doing ALL the things I find so annoying, especially if a loved one was ill.

I try to slow down and separate my feelings from what is actually happening. The family has their say, and then I ask the patient directly what I need to. I don't know why you're SO wasn't brought back. The nicest explanation I can think of is that they were expecting a stretcher to open soon, and were saving it for him, but bringing back people to fill exam rooms for mid level practitioners. Since the nurse didn't tell you that though it seems unlikely.

[wildcats]

wildcats

Thanks for the reply.

What I meant was, I see my difficulty with that type of patient as something negative, and I have to conciously put my gut reaction aside when they come in. I also find it hard when visitors answer all the questions because I need to assess the patient in so many different ways (mental status, understanding of their illness, severity of symptoms) and 90% of the time patients add a lot more to the assessment. At the same time I can easily see myself doing ALL the things I find so annoying, especially if a loved one was ill.

I try to slow down and separate my feelings from what is actually happening. The family has their say, and then I ask the patient directly what I need to. I don't know why you're SO wasn't brought back. The nicest explanation I can think of is that they were expecting a stretcher to open soon, and were saving it for him, but bringing back people to fill exam rooms for mid level practitioners. Since the nurse didn't tell you that though it seems unlikely.

I couldn't even begin to imagine what its like to deal with patient's family members in the ER ... I probably was annoying the triage nurse to no end lol.

I think everyone probably has issues with certain types of patients ... I am a new LPN so I don't really know what I may have to put aside to provide care.

I know I am way OT but I am in a small city with 2 hospitals and both ERs are always full. It's amazing. And one of the hospitals is a rather large university.

[Shadelyn]

All I can think is what about the Dr. that didn't CT her belly? The article rips the nursing staff, but of couse nothing of the Dr. Articles like this make me cringe and I hope to avoid being triage at all costs in my career. She had been there three times for this problem, but how many for others. I'm sure that all of you can recite the names of your frequent flyers off by heart. I know that I don't take ours seriously anymore, but do they get the medical care and testing that they "need" everytime? Sure do. I know people that probably glow in the dark now that they've had 20+ A/P CT's and Xray's. I have done so many EKG's on a few people that I know don't need to bring stickers because they're still wearing them. Our staff definately grumbles about these people but they get the testing that their complaint warrants.

On the busiest of days this could happen to anyone. I would like to know how many patients were there and what else they were working on. It's sad to say, but who even knows if she would have made it had they found it that time. The problem lies in the original miss the first time she came through.

Also maybe in the article or in the other thread there was mention that she was at a disadvantage there because uninsured. Do you know about that when you see patients? I know in our computer there is no notation of insurance status. You could seek it out but who has the time. It's not like triage pokes their head out of the window and announces, "The next insured pt. may come back, the rest of you can sit out there and die."

[Altra, BSN, RN]

All I can think is what about the Dr. that didn't CT her belly?

Did the article state that she did not have an abd CT at any one of her recent visits? If so, I missed it.

[platon20]

All I can think is what about the Dr. that didn't CT her belly? The article rips the nursing staff, but of couse nothing of the Dr.

It is NOT standard medical practice to CT everyone with belly pain. That being said, I suspect that the failure here was on behalf of both the earlier doctors who saw her and the triage nurse who failed to evaluate her on her 3rd visit.

Even if the doctors on her previous visits totally screwed up and failed to manage her properly, the triage nurse still has a responsibility to give her a "fresh" look, even if she comes back 20 times.

[TrudyRN]

When I read the article it said the patient had been seen several times in the past week, and in fact had just been released when she complained of increased pain, and started writhing around on the floor, probably with impressive sound effects.

If I had been the triage nurse, AND if I knew she had been seen multiple times by multiple docs in the last week, and had a history of drug abuse, she would have been retriaged as a 4 and encouraged to expect a long wait. Wrong call, obviously, but she had just been seen.

Given 5 or 6 people that are complaining of incredible pain and haven't even been seen once vrs someone who just got worked up, and discharged I'll get everyone seen once before starting at the end of the line again. If she was cussing or creating a disturbance, yep, I'd call the police.

It's a horrible tragedy, but I can absolutely see it happening with the most attentive and sympathetic triage nurse.

I'm really sorry about your job, Tazz.

What has kept me out of trouble for many years is that I try to not go by the numbers and how aggravating the patient might be. I find I'm better off going with facts (VS and the like) and with my gut. Yes, sometimes it's hard.

Sometimes it's the patient's color (gray, too bright, too flushed, too pale, NOT RACE COLOR SO DON'T FLAME ME), over all posture and facies, mental status, and the like. Sometimes it's just a sense that I get that a patient is in trouble and I ALWAYS go with my sense.