Triage nursing: How do you keep your sanity!?

Kuriin, BSN, RN · Jun 14, 2017

Are there no urgent cares in your town? Do you have a rapid care area for areas such as lacerations?

Wuzzie · Jun 14, 2017

I hated being in the "penalty box" and one thing for sure is if I had people beating on the windows and cursing and security wasn't helping I'd be calling the local police for help and wouldn't give a damn what administration thought about it.

~Mi Vida Loca~RN, ASN, RN · Jun 14, 2017

I can offer no advice as I LOATHE triage. It doesn't matter if there are any urgent cares, you can't refer people to them or recommend them to go there for that visit anyway.

I ticked enough people off tat one point that they stopped putting me out there in one hospital. :|

Nalon1 RN/EMT-P, BSN, RN · Jun 14, 2017

I don't mind triaging, I loath when I have nowhere to put them.

What you describe is what really annoys me. Even when you explain you have no beds/rooms to put them into and cannot give a time to get back, they still ask, over and over and over and over...

When you have nowhere to put them, you can only tell them that. There are solutions that help, such as having a provider screen them and get orders going, but that means you need somebody to do labwork. Meds, unless you have a nurse assigned, not going to happen. If no nurse, you have the provider and/or charge pressuring you to do these things as well as triage. I just say no, I am triaging, not treating. If you want me to treat, then put someone in triage and I will treat.

Kuriin, it is a violation of EMTALLA to send them to another facility once they come in your door until they have been see, treated and/or stabilized. Many areas do not have Urgent care centers or have limited hours.

allnurses Guide · Jun 14, 2017

They took away our glass, we just sit there behind a low desk that anyone could go straight over. Don't even have a dedicated security officer, and we are a regional trauma center.

I've told people, "I have 36 beds in the back, and over 40 people.... which means I have people sitting in the halls." and "you never want to be the one I rush back".

I also have to explain that we have a "fast track" area where you see a PA, or sometimes an NP. So "all these not-so-sick folks are going ahead of you, are not going to get a full medical workup such as you need, you will be seeing a fully board certified emergency room physician for your complaint, they aren't." It works sometimes.

emergencynursy · Jun 14, 2017

We have a "fast track" that sees Level 4's and 5's, but it's one nurse and one PA. It's 5 rooms.

WKShadowNP, DNP, APRN · Jun 14, 2017

They took away our glass, we just sit there behind a low desk that anyone could go straight over. Don't even have a dedicated security officer, and we are a regional trauma center.
I've told people, "I have 36 beds in the back, and over 40 people.... which means I have people sitting in the halls." and "you never want to be the one I rush back".
I also have to explain that we have a "fast track" area where you see a PA, or sometimes an NP. So "all these not-so-sick folks are going ahead of you, are not going to get a full medical workup such as you need, you will be seeing a fully board certified emergency room physician for your complaint, they aren't." It works sometimes.

At my former hospital the fast track was just overflow and the PAs and NPs did full work ups all the time.

But yes, for the most part I have to often explain why so and so is going back when and why someone else isn't .

Editorial Team / Moderator · Jun 14, 2017

I hated being in the "penalty box" and one thing for sure is if I had people beating on the windows and cursing and security wasn't helping I'd be calling the local police for help and wouldn't give a damn what administration thought about it.

I also call it the penalty box, lol.

bgxyrnf, MSN, RN · Jun 14, 2017

I also loathe triaging, for two reasons.

The first is that it can become like working on an assembly line... next, next, next...

The second is that I often have nowhere to put people and I feel badly that suffering people have to wait. I've had a kidney stone and I get it... but there's nothing I can do... if there aren't any rooms, there aren't any rooms.

I try to express sincere compassion and empathy to those who are suffering and I try to ignore the donkeys because I know it's not me that they're venting on, it's the representative of the broken system (who, unfortunately, is me).

As much as I'm able, I try to utilize standardized orders where they're available or to solicit appropriate orders from the pod docs so we're at least keeping things moving as well as to give me some objective data to re-prioritize my rooming.

allnurses Guide · Jun 14, 2017

At my former hospital the fast track was just overflow and the PAs and NPs did full work ups all the time.
But yes, for the most part I have to often explain why so and so is going back when and why someone else isn't .

Oh, ours do too. However, they aren't supposed to get the ones who need it! (I know what you mean about the overflow). Seriously, you ordered a CXR for a sore throat and afebrile cough of a day??

JKL33 · Jun 14, 2017

Is this of any concern at all to your admins? There are some very large systems out there that have been able to significantly improve wait times in recent years, using various measures and making adjustments in multiple steps of the process. This has its pros and cons, of course.

If you have been able to observe any specific factors affecting the situation at your place, you might consider seeing if mgmnt is open to a discussion about it (not a complaint, mind you, but an offer to study the issue or to research some aspect of it, etc.). For instance, say you observe that your rooms actually are emptying but then there's no one to clean them in a timely manner - there are several workable solutions for problems such as this and others. If this is something that appeals to you, I'd probably advise getting a little more solid triage experience under your belt before approaching anyone - and know your environment and the odds of positive reception before-hand!!

I am not a proponent of nurses stressing ourselves and effectively accepting responsibility for these situations which are out of our control. With that in mind, I keep things moving the best I can using any protocols which might be in place, make good solid judgments, keep a close eye on the people I've already triaged, re-prioritize as necessary, provide reassurance as much as possible, speak kindly as often as possible ("please let me know if you are concerned that something with your condition is changing") and beyond that, well...I put myself in emotionally-detached mode, to some extent. I love my job but I'm well past the point where voluntarily rolling on the floor has any effect on me. I'm very practical about it. Sometimes I recheck a pulse or a pulse-ox and then kindly state, "Your vitals are stable and I think everything's still okay here. I know it is frustrating to have to wait". When drama rules, it usually results in some patients who are not sick getting a bed before some patients who are. I avoid this as much as humanly possible because it violates patient safety and my personal sense of ethics. Overall, stay calm. People can smell/read our frustration, stress, and anxiety, and sometimes are provoked even more by it - thinking if they just push the envelope a little further, they will be successful.

Side note - it might not be a terrible idea, in the interim, to try to befriend some of the security personnel to see if that changes their responsiveness at all. This is a perfect situation for security input, as it CAN get out of control. Call them down, say "Sorry to bother you but I'm concerned that tensions are running quite high in the WR. Can you keep an eye on me for awhile so I can safely keep triaging people?" If you get anyone willing to help your cause, make sure to thank them and try to build a working relationship between your departments.