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.
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.
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.
Specializes in emergency, neuroscience and neurosurg..
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.
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
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.
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.
Supervisor. I guess what you all are saying is that a RN should be sitting at the "greeter desk" and NOT a clerk, correct? Clerks should work in the back nurse's station ONLY, right?
Supervisor. I guess what you all are saying is that a RN should be sitting at the "greeter desk" and NOT a clerk, correct? Clerks should work in the back nurse's station ONLY, right?
The problem lies in you, as a clerk, determining who comes back and who waits ... and who looks like they're in distress and who doesn't.
The most effective triage/waiting room set up I've seen was this:
At the front desk were seated one or two clerks who greeted patients and took name, DOB and chief complaint. This information was immediately entered and the patient would pop up on the electronic tracking board visible on every computer in the department. Urgent/emergent complaints like chest pain, stroke symptoms, etc. would get grabbed out of the queue by the charge nurse and taken back to a room - they were not triaged out front if at all possible.
Right behind the front desk, in a glass enclosed office, was the triage nurse. The front door and pretty much the entire waiting room were visible to the triage nurse, so even if he/she was currently triaging someone, he/she could look up and eyeball someone new walking in to make sure they weren't in obvious distress.
Otherwise, patients were triaged by the triage nurse in the order that he/she thought appropriate based on appearance/chief complaint.
In other words, OP, as a clerk you can collect information - why the patient is here - but your only responsibility should be to pass it on to someone else (an RN) qualified to make decisions based on that information.
Specializes in Emergency, Critical Care (CEN, CCRN).
We also use a "RN greeter" system as part of a two-phase triage. The RN greeter and registration clerk sit right next to each other at the triage desk, and the RN takes the CC and does an eyeball assessment while the reg clerk takes the patient's name and DOB to put into the computer. The greeter decides at that point whether the patient should go to Resus, needs a STAT ECG, or can go into the main triage queue. Full triage is then done by a triage RN, who takes a full CC, vitals, basic history and meds list, assigns the patient a treatment class and priority (Acute Care/Minor Care, ESI I-V) and also has access to the "advance treatment" orders pack (STAT ECG, SL NTG for chest pain, PO Tylenol/Motrin for uncontrolled fever, etc). After triage is completed, patients go back to the waiting room until they're taken back to the main department. EMS traffic goes to a separate ambulance bay where the RN greeter and triage functions are combined, but the same basic process applies.
I agree that there's a huge patient safety and liability issue in the cards here. You, as a clerk, shouldn't have any contact with the assessment and prioritization of patients at all. Nor, for that matter, should any unlicensed personnel.* This needs to be reported, sooner rather than later.
* Paramedics do assign priority to transports based on patient condition, but that's strictly in the prehospital setting, and their licenses cover that activity in that setting. In the context of hospital-based triage, "licensed personnel" is an RN or higher.
I don't understand how these people can ask you to use nursing judgement to make important decisions. You don't have nursing judgement. It's ridiculous. To be safe, until you get this sorted, I would rush everyone back as an emergency. You can't go wrong with that. If they don't like it, they'll need to triage.
Lunah, MSN, RN
14 Articles; 13,773 Posts
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.