I've finally hit my one-year mark as an emergency nurse, and now I'm allowed to triage. Our department uses the "nurse first" and an RN is the first person the patient sees as they're checking in. When the department is short-staffed and our rooms are full, it gets difficult to get patients back. We are the only hospital in town, and patients tend to get frustrated when they cannot be seen after 4 hours for a minor problem. My question is, how do you guys deal with the patients who beat on the windows, yell and curse at the nurses, and fall out in the floor into a temper tantrum? My patience is wearing thin, and I could definitely use some tips!
How do you triage your patients in your ER? How do you keep a steady flow as a triage nurse?
How do you control patients when your security isn't helping?
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.
Are you allowed to SUGGEST that they will get seen sooner at an Urgent Care? You are not SENDING them, not refusing to see them, just SUGGESTING and then the patient can make the decision to go elsewhere?
Are you allowed to SUGGEST that they will get seen sooner at an Urgent Care? You are not SENDING them, not refusing to see them, just SUGGESTING and then the patient can make the decision to go elsewhere?
Nope. Even suggesting can be construed as an EMTALA violation by some, so it's better to not even bring it up!
Nope. Even suggesting can be construed as an EMTALA violation by some, so it's better to not even bring it up!
Exactly. Once on hospital property, any mention of going to an urgent care or another ER to be seen faster by staff would be considered a violation.
Now upon discharge, you can mention that there are Urgent Care facilities that are able to handle many types of care needs and are usually faster.
I have had many say that those require payment up front so they come to the ER since they don't have to pay first (yet still gripe about the long waits).
You are allowed to tell them, there are X people waiting and, Y is the longest wait."
When they complain I tell them, " based on my triage I think you should get a medical screening by a provider, but I cannot hold you here against your will, if you really want to leave, for whatever reason, I am forced, by law, to let you determine your own treatment"
Unless of course they are not free to go, in which case I need to find a room
Personally, I love triage. How you handle the situation all depends on what's going on, but I have a very 'tough love' attitude. If they are banging on the windows I will, very firmly, tell them to stop doing that or I'll call the police and have them arrested. If they fall out in the floor and I suspect it's just being dramatic, I'll have the tech or myself check the vitals and evaluate the patient. If they yell or curse at the staff , I will get in their face and tell the something like "You will NOT speak to the staff like that, do you understand me?!" , and I'm not very nice about it, not at all. Rarely do they ever take it beyond that, but if they do I will then say something like "Since you want to act out, I'm going to get the Police over here and have you explain yourself to them" and I've only had one patient ever push it beyond that, if they do keep your word, call the cops and let them deal with the 'disorderly conduct'.
Triage will make you a very strong person and nurse. It's not for the faint of heart or for the weak because you have to be able to stand up to a mob and put them in their place, quickly.
Kooky Korky, BSN, RN
5,216 Posts
Are you allowed to SUGGEST that they will get seen sooner at an Urgent Care? You are not SENDING them, not refusing to see them, just SUGGESTING and then the patient can make the decision to go elsewhere?