triage reassessment

[dewp_63]

I work in a suburban hospital ER - we have 10 beds, 3 fast track beds and 2 hallway beds (just don't tell jchao!). We see 70-90 patients a day. Our nurse manager wants us to retriage/touch base with all patients in the waiting room every hour. We have 1 triage nurse (at least until 11pm - then everyone catches triages), and often you cannot get out of triage to get an ice bag without having 4 more patients lined up to triage! The NM not only wants us to go out to the waiting room, but she expects us to write a note on every chart...

Our usual staffing pattern is: 1 MD, 3 RN's from 7p-7a (I work nights - not sure about day staffing), 1 RN 11a-11p, and we're supposed to have an LVN/LPN 5p-3:30a (don't have enough hired, so we often have to do without! ) Our fast track is open noon to midnight, so we have a PA during those hours. We are strongly discouraged from going on diversion to EMS- even when there are NO BEDS in the hospital (which seems to be the case more and more!)

The NM thinks this will help with patient satisfaction and decrease our number of "left without being seen" patients. I know when I'm in triage, there just isn't time. When I'm on the floor - I'm doing good to keep up with my patients! HELP! Anyone have any suggestions to facilitate this?

By the way - we get a new nurse manager next month - maybe she'll be more realistic. Our current manager is responsible for 2 ED's in two different hospitals 15 miles apart - we never see her except for staff meeting...

[gwenith, BSN, RN]

Hang in there and hope for someone more reasonable! Good luck! I always fell like asking someone like this if they have a broom and when they ask why tell them it is so I can tie it on my backside and sweep the floor while I do all the rest!!!

Sorry sarcasm showiing.............

[debbyed]

We have a patient rep. assigned to the ER 1100 to 1900. She makes rounds of the waiting room and of all the rooms in the back. This has helped with our patient satisfaction and she notifies the triage nurse or charge nurses is the patients has any medical complaints/questions. In most cases she just answers questions about wait times and doles out blankets, pillows and coffee/juice etc.

[healingtouchRN]

oh Gosh, that sounds like where I left! I don't miss it, nor do I miss the boss I had ! When I feel unsafe I leave!!

[jetsetter]

I would encourage you to wait it out and see if the new nm has a different perspective. new managers often have "get acquainted" type meetings, this would be a good opportunity to make a positive suggestion on handling this problem. Good Luck!

[LilgirlRN, ADN, RN]

Just remember that being the triage nurse you do have a responsibility to check on your patients. It's not just the nurse manager wanting you to do it, you cover yourself by doing this. We've had a few cases of being full in the ER and having someone wait only to find them DEAD in an hour. Trust your instincts, make room for someone if you are uneasy about them. Get everyone that you work with involved in keeping an on the triage patients since you all triage at night. The patients themselves will sometimes help with triage, they will often insist on another sicker looking patient come back first. Maybe your new manager will have some ideas, I have no idea what they maybe however. I've been doing this for a very long time and we always have the same triage problems. Fast track did help us some, so maybe get your LPN hired and things will start looking up. Good lucl :) Wendy