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Triage

Hi guys. I thought I'd come ask you all since I can't get answers from my employer on this. I'm trying to learn how to triage people properly (as a clerk) but it seems each nurse wants it done a certain way and it confuses me. I feel like I'm not putting people back in rooms when I should and telling them to come on back when I shouldn't. !?! I was told to "use my best judgment" when deciding who needs an EKG immediately and apparently my judgment is poor. I told a 19 year old complaining of chest pain to sit down and wait when I should have sent her to the cardiac room. She's young, looked healthy, wasn't laboring to breathe and had no history of heart problems. Turns out she was just having a panic attack. How was I wrong in this situation?

Also, I thought a man might be having a stroke so I wrote his chief complaint as "possible cva" and sent him into a room and told the nurse immediately. She got irritated and said "There's like 10 people in front of him. Now I have to send him back out in the waiting room and he is going to be ******!"

?!?! I just thought...a stroke is serious and demands priority? No? Maybe I don't have enough medical experience to be working this job yet.

Any input/advice is greatly appreciated.

nurse2033, MSN, RN

Specializes in ER, ICU.

No offense but if you're a clerk, you have no business using "your best judgement" to make medical decisions. I'm telling myself that this can't be true, that some manager is putting a clerk in charge of triage. Can you clarify your training or qualifications? Triage must be done by a nurse. A clerk can be a greeter and start registration, but not make any medical decisions. You should not be put in this position. For us to teach you all you need to know means sending you to nursing school. Please report this to your state board of nursing as your employer is creating an unsafe environment.

Medic2RN, BSN, RN, EMT-P

Specializes in ER, IICU, PCU, PACU, EMS. Has 14 years experience.

Please don't take this the wrong way, but I'm wondering why a clerk is performing triage in the first place.

Meowmixer

Specializes in PICU.

Agreed. As a nursing assistant i took names, birthdays, and vitals. As a unit clerk i just put in orders, none that weren't written or yelled. Something is wrong there. You're confused as to what you should be doing because you shouldn't be doing it. (Again, no offense)

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Triage is to be performed by a nurse. Sorry, this isn't in your job description and heading for a disaster.

ObtundedRN, BSN, RN

Specializes in Critical Care. Has 6 years experience.

Triage is to be performed by a nurse. Sorry, this isn't in your job description and heading for a disaster.

Not to mention could probably land some people in legal hot water...

Neveranurseagain, RN

Has 26 years experience.

Let me know what hospital you work at so I can choose another one! :D

Check with your state BON--triage needs to be done by an RN.

:) Okay, perhaps I need to be a little more clear. I am not "triaging" the patients (taking vitals and asking them very detailed questions to further narrow down a diagnosis). That's what the triage nurses are for. They have asked me to perform a very basic assessment to establish if a patients needs to be go back in one of the 5 triage rooms or if I should tell them to sit down in the waiting room. If a patient complains of chest pains, I need to get them into the cardiac room so a nurse can perform an EKG within FIVE minutes! It's my job to decide if they get to jump ahead of the 20 people that have been sitting in the waiting room for hours. But yes, I have them fill out a form first and chat with them very briefly about what's wrong. Today, I thought someone was having a stroke so I sent them back immediately. Nurse got irritated because she wasn't...which I understand why, but at the same time, I don't feel comfortable telling someone I think is in a life threatening situation to go have a seat for 3 hours. I realize my opinion is medically ignorant but is still of concern.

Is this different from your hospitals? Do you not take patients back to be triaged based on the severity of their condition? I'm probably over-thinking it all. I'm sure I'll figure out the correct process soon enough.

llltapp

Specializes in ER, ARNP, MSN, FNP-BC. Has 17 years experience.

If the nurses are asking you to make a judgement call, then they need to shut up when you do. So what if the suspected stroke wasn't a stroke. What if it had been? Just keep doing your job and tell anyone that gives you any crap "bite me" LOL.

by the way, a paramedic performs this function in my ER. You are being asked to do more than you are trained to. I would highly recommend you get specific written protocols i.e. "chest pain complaints go right to triage/back of ER whatever." you are not trained to assess.

Edited by llltapp
left something out

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 12 years experience.

They have asked me to perform a very basic assessment to establish if a patients needs to be go back in one of the 5 triage rooms or if I should tell them to sit down in the waiting room.

You should not be performing any assessments, basic or otherwise. What you are doing is the definition of triage: sorting out patients. This is a very bad idea.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

the hospital could get the same result by asking patients to fill out a slip as they arrive with name and complaint. Then the triage nurses look through the slips and pick out any they want to see first, or eyeball everyone in the triage area and call the sickest looking in. I think the current practice puts you and the hospital at risk.

the hospital could get the same result by asking patients to fill out a slip as they arrive with name and complaint. Then the triage nurses look through the slips and pick out any they want to see first, or eyeball everyone in the triage area and call the sickest looking in. I think the current practice puts you and the hospital at risk.

Hm. I don't guess I understand. If someone comes in and says they think they're having a heart attack, your clerks ask them to fill out a form and sit down? Or do they make a judgement call and interupt the nurse and tell them they need an open room? We usually have about 7-10 reg. forms stacked up waiting to be looked at. Does your er not have patients stacked up like that?

Sorry, don't mean to be difficult here I'm just trying to figure out if there is something seriously wrong with what's going on or if my ED is just a lot busier. ?!

Edited by Ciale

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 12 years experience.

Yes, there is something seriously wrong with an untrained person performing triage - because yes, that is exactly what you are doing ... triage is sorting, you are sorting. Just because you're not taking vitals and a history doesn't mean you're not performing triage actions. Yes, our triage gets stacked up, but it gets managed by a triage nurse.

Our patients see a nurse first - they sign in with a complaint at the window where the triage nurse sits. The triage nurse makes a determination about the order in which patients are seen. Our clerks do nothing more in this context than a quick registration of the patients, which is as it should be. You and your facility are at risk if you are doing triage. Huge liability. HUGE. Not to mention it's dangerous for the patients. No offense to you, seriously -- but be aware this is a problem.

ObtundedRN, BSN, RN

Specializes in Critical Care. Has 6 years experience.

To the OP: You asked how some of our facilities do things.

My hospital has a triage nurse sitting next to the registration clerk. After every registration, the triage nurse immediately sees the patient briefly to find out the complaints, a tech does a set of vitals, and then the nurse determines if immediate treatment is needed.

When a patient is taken back, immediately or after waiting, they see a different triage nurse, and a triage MD who then start the care for the patient.

they sign in with a complaint at the window where the triage nurse sits.\.

Ah. That is the key difference. We don't have a nurse sitting up front because they are with a patient 95% of the time. I'm not offended. I agree that it is not a good practice to have me "use my best judgement" when I have little to no training on this matter. Yikes. Well, I'll have a talk with my director and check with the BON to see what should be done. I don't feel comfortable working triage at the moment. Thankfully, I've mostly worked in the back at the nurses station.

Thank you all for the feedback!!!

edrnbailey

Specializes in emergency, neuroscience and neurosurg.. Has 13 years experience.

Hm. I don't guess I understand. If someone comes in and says they think they're having a heart attack, your clerks ask them to fill out a form and sit down? Or do they make a judgement call and interupt the nurse and tell them they need an open room? We usually have about 7-10 reg. forms stacked up waiting to be looked at. Does your er not have patients stacked up like that?

The disconnect is not in the process of triaging patients but that you, a clerk, is doing it. It is mandatory that all patients be evaluated by an RN initially. As a registration or unit clerk you do not have the education, skills, or experience to "assess" the patients. The word "assess" in itself is part of what defines nursing and is unique to nurses. Deciding which patients need to be seen by the nurse first is the nurse's responsibility not yours. That is what an assessment or triage is, evaluating a patients c/o along with vital signs, objective data, and subjective data to dermine order and placement of patients.... this is the very essence of triage itself and cannot be perform by unlicensed personnel.

You are working outside the scope of your practice. You should follow up with your state Board of Nursing for further clarification of assessments and qualifications to perform those. In some states it is illegal to practice nursing without a license and you could face criminal charges if it were ever pursued ( ex: bad patient outcomes and nurses/ administration are looking to shift blame to cover themselves).

I feel for the OP. Our ER just went from having an LPN or paramedic at the "greeter desk" to putting my department (registration) out here. Basically, we're supposed to short reg the pt, get their CC and then call for triage. If they are "having chest pain or appear to be in distress" call a nurse to the waiting room on the radio.

When we first started doing this, I expressed concern that you can't always tell when a pt is "in distress". I have seen many the gentlemen (for some reason it always seems to be the guys) downplaying their symptoms for whatever reason and then next thing you know, they're being flown to another hospital because they're having a massive MI. The response I got was "come on, you can tell when someone is in distress just by looking at them". Well, sometimes but on the other hand, the completely untrained people in my department have 60 year old chest pain patients filling out forms and "having a seat" to wait for the triage nurse to come and collect them. Or someone having a severe asthma attack who can't even speak and they're trying to get demographic info from them before calling someone.

I don't feel too uncomforable out here because I tend to err on the side of caution and even though I'm not a nurse I am almost there (god willing). But it really is just a disaster waiting to happen.

TiggerBelly

Specializes in ALF, Medical, ER. Has 4 years experience.

Wow! As a clerk, assessments should not be part of your job description. Now when I am out in triage, if there are 20 people waiting to be triaged and someone comes in looking distressed or extremely short of breath, I alert the triage nurse of the situation. She will then stop what she is doing and come assess the patient. It is then the NURSE'S responsibilty to decide where that patient should go. That responsibility should not be put on you. That is a lawsuit waiting to happen

back2bRN

Specializes in ER, L&D, RR, Rural nursing. Has 15 years experience.

At one of the tertiary centers they have an RN "greeter", from my understanding they(the Rn) gather the cc and do a very basic assessment then determine if they get a number and wait in line or go and be assessed immediately by one of the triage nurses.

The idea of a clerk with limited experience and education doing what experienced triage nurses should be doing is terrifying and should make you extremely uncomfortable.

Just wanted to agree with what's already been stated.

Please talk to your supervisor about this and I would have to say that if they don't change their practice immediately, it must be reported. This is extremely dangerous, may be illegal, and is most definitely not in the patient's, the hospital's nor YOUR best interest.

Again - "triage" is *not* the writing down of information, it is the act of sorting/prioritizing based on the degree of urgency of the complaints.

Hope you will post an update after you talk with your supervisor. Good luck to you!

Oh, BTW, I was about to say something along the lines of 'shame on your RNs for going along with this' .... then I started to wonder at the possibility that THEY could be the ones asking you to do extra things outside of your actual job description, to 'help' them. So I guess I must ask, is it your supervisor who has assigned you to make determinations about the urgency of patients' complaints, or are only certain nurses asking this of you? Or maybe I'm just grasping at straws because this is truly unbelievable. :(