To help those patients better understand how we work and how not to abuse the system.
For ALL Patients...
Please know why you came to the ER and what symptoms you are having. How long has it lasted? Where is it located? Et cetera.
Please know your medical history and your medications.
For patients who go to the ER by ambulance...
First and foremost, please do not think that by going to the Emergency room by ambulance will get you to the back quicker than those waiting in the waiting room. If you are not of higher priority, you will be sent to the waiting room so that the higher acuity patients are allowed to the back first. It's just how we operate, we are not a hotel, we are a hospital. Our job is to help the sickest people get better. When you arrive to the hospital you are greeted by a nurse who is trained to determine if you need to be placed in a bed immediately or you are able to wait a little longer in the waiting room. Here's where it splits into two parts. For those who are placed in a bed upon arrival, this must mean you are very ill. You will be greeted by your nurse almost immediately upon arrival to your bed. She will start asking you some questions about why you needed to come to the ED and about your medical history. Then the doctor will follow and determine your diagnosis and what tests need to be ordered to confirm their hypothesis.
For patients arriving by walking-in.
First you will be greeted by the triage nurse who will direct you to fill out a form with your basic information such as name and date of birth and the reason for your visit. From your less than 60 second conversation he/she will determine your acuity. From there you will be asked to sit and wait for your name to be called. When your name is called you will be greeted by another nurse who will take your vital signs and ask you about your medical history. From there, you will be asked to wait in the waiting until there is a room for you. Now for some patients, it will not require all of these steps because they are very ill and we have to bypass some of those things. For example, people who are in shock, having a stroke, GSW/Stabbings, having a heart attack (myocardial infarction), etc. will be immediately brought to the back and given treatment.
Thursday, March 21, 2013
The Triage Desk
Triage. Every ER nurse's nightmare...
There is a lot of emphasis on patient satisfaction these days. Reimbursement is starting to depend on it. So the goal is to make the patients happy. Noble goal. Triage is the gateway to the "patient experience". Triage is first contact. It sets the tone. Blah blah blah. The triage staff needs to be polite, professional, etc. More noble goals. As a volunteer, I was required to attend training on customer service and sensitivity.
Reality: triage is difficult and not an easy place to be. You are bombarded continually from all different directions: As a volunteer and student nurse I had two jobs, information desk and keeping an eye out for the sickest of the patients.
Patients presenting for care, sometimes all at once...
Flow desk phone calls, charge phone calls...
Dealing with relatives, friends, and visitors.
You are an information desk for the whole hospital
-looking up where patients are
-directing everybody everywhere
Dealing with unhappy people in the waiting room
People are impatient, angry, hysterical, anxious when they present to triage. They don't understand why they can't go right back. Sometimes people act out in triage: crying, yelling, sometimes throwing themselves on the floor. Often times there are people in back of triage in carts. These are the people who can't be in the lobby. A hosptial ER does not operate by who gets there first, the sickest people are seen first. Patients please get that in your head. And we are open 24/7 so there might be times when you can't be seen right away or be placed in the back right away because we have no more room.
Add to this the constant worry of the triage staff about putting people in the lobby who shouldn't be in the lobby. In other words they are sick enough to go back, but there are no beds. Hopefully they'll be okay in the lobby.
In the middle of all this lies the triage nurse, trying to manage it all. You are stressed in that role. You are abused in that role. You are sometimes overwhelmed in that role. To expect nurses not to express their stress, frustration is unrealistic. We who work triage are human. We are expected to be superhuman and do all of this with a continual smile. Its not possible.
Whats the solution?
1) Be realistic with patients about wait times.
2) Don't keep people in the ER for 4-5 hours at a time, backing up the waiting room.
3) Allow your paramedics/techs to do more things that they are able to do. You are holding them back. If they are qualified and trained to start an IV, let them start some normal saline and the nurse can come in with the meds and give those. It would make the job of the nurse much more easier.
4) Allow volunteers to do more to assist the staff. Give us formal training, we are up for the challenge. I'm speaking for volunteers in general, not myself. Since I am going to school to do the many things a nurse does I am able to do some of those things. For the rest of us, if we know how to perform an EKG or place patients on monitors let us do that. You can observe us and test us every so often to make sure we are competent to complete the task.
*Some of the content of this blog is borrowed from another blogger... I just changed what was needed to reflect my opinions about triage.
There is a lot of emphasis on patient satisfaction these days. Reimbursement is starting to depend on it. So the goal is to make the patients happy. Noble goal. Triage is the gateway to the "patient experience". Triage is first contact. It sets the tone. Blah blah blah. The triage staff needs to be polite, professional, etc. More noble goals. As a volunteer, I was required to attend training on customer service and sensitivity.
Reality: triage is difficult and not an easy place to be. You are bombarded continually from all different directions: As a volunteer and student nurse I had two jobs, information desk and keeping an eye out for the sickest of the patients.
Patients presenting for care, sometimes all at once...
Flow desk phone calls, charge phone calls...
Dealing with relatives, friends, and visitors.
You are an information desk for the whole hospital
-looking up where patients are
-directing everybody everywhere
Dealing with unhappy people in the waiting room
People are impatient, angry, hysterical, anxious when they present to triage. They don't understand why they can't go right back. Sometimes people act out in triage: crying, yelling, sometimes throwing themselves on the floor. Often times there are people in back of triage in carts. These are the people who can't be in the lobby. A hosptial ER does not operate by who gets there first, the sickest people are seen first. Patients please get that in your head. And we are open 24/7 so there might be times when you can't be seen right away or be placed in the back right away because we have no more room.
Add to this the constant worry of the triage staff about putting people in the lobby who shouldn't be in the lobby. In other words they are sick enough to go back, but there are no beds. Hopefully they'll be okay in the lobby.
In the middle of all this lies the triage nurse, trying to manage it all. You are stressed in that role. You are abused in that role. You are sometimes overwhelmed in that role. To expect nurses not to express their stress, frustration is unrealistic. We who work triage are human. We are expected to be superhuman and do all of this with a continual smile. Its not possible.
Whats the solution?
1) Be realistic with patients about wait times.
2) Don't keep people in the ER for 4-5 hours at a time, backing up the waiting room.
3) Allow your paramedics/techs to do more things that they are able to do. You are holding them back. If they are qualified and trained to start an IV, let them start some normal saline and the nurse can come in with the meds and give those. It would make the job of the nurse much more easier.
4) Allow volunteers to do more to assist the staff. Give us formal training, we are up for the challenge. I'm speaking for volunteers in general, not myself. Since I am going to school to do the many things a nurse does I am able to do some of those things. For the rest of us, if we know how to perform an EKG or place patients on monitors let us do that. You can observe us and test us every so often to make sure we are competent to complete the task.
*Some of the content of this blog is borrowed from another blogger... I just changed what was needed to reflect my opinions about triage.
My calling as a nurse
While volunteering in the Emergency Department, I felt a calling. It was to become a nurse in the Emergency Department. I was already enrolled in a BSN program, but I found where I want to be when I finished school and become licensed. There are many things that go on in an ED that many people outside of the unit do not know. Many nurses who come down from other units to lend a hand are confused as to how we operate. You can't wait for doctor's orders, we are an ER, seconds count between life and death. You go with your gut instinct and protocols. It's not for everyone and it takes a very tough person to be a nurse. It's fast paced, stressful, and demanding. I got to observe what the nurses do from initially meeting the patient to getting them admitted or discharged.
I'm here to give people an insight on how the healthcare field really works. What you see on TV is not really what you see in a real Emergency Department. Most of the things you see on TV are scripted. Sure some of that stuff looks real, and maybe real. On TV you see doctors doing many things, but in reality doctors talks to the patient for about 5 minutes and then writes orders for the nurse to carry out and delegate. It's really the nurses who do the hard-work. I believe that by becoming a nurse first prior to becoming a doctor will really help me be a great physician who is able to work with everyone on the healthcare team. Some doctors are just bad people that think they know everything just because they have the title MD/DO and they read stuff out of a book or they heard about it in medical school. A nurse who has been doing her job for more than 10 years has probably seen more than you have in school.
I'm here to give people an insight on how the healthcare field really works. What you see on TV is not really what you see in a real Emergency Department. Most of the things you see on TV are scripted. Sure some of that stuff looks real, and maybe real. On TV you see doctors doing many things, but in reality doctors talks to the patient for about 5 minutes and then writes orders for the nurse to carry out and delegate. It's really the nurses who do the hard-work. I believe that by becoming a nurse first prior to becoming a doctor will really help me be a great physician who is able to work with everyone on the healthcare team. Some doctors are just bad people that think they know everything just because they have the title MD/DO and they read stuff out of a book or they heard about it in medical school. A nurse who has been doing her job for more than 10 years has probably seen more than you have in school.
Volunteering at the hospital
In January 2012, I decided to volunteer at a big teaching hospital and level 1 trauma center in Dallas. I filled out an application, had an interview, and attended orientation, then started with delivering magazines to the many units and departments within the hospital campus. Yes, delivering magazines for the first 2-3 months of volunteering. I can't remember exactly how long. It helped me to become familiar with the hospital and it also allowed me to see which department I would like to be placed in. Then I moved on to selling popcorn. Popcorn was only for 2 hours each day I was there, because the lady who sold the popcorn has to have a lunch. I was fine with that, I got to interact with many different people.
I call this the first day of official volunteering, I was placed in the new Cancer Hospital on an Oncology ICU unit. I was introduced to the unit secretary and the nurse supervisor. Then I was placed in the nurses station to answer telephones and call lights, fax orders, make new charts, input orders, etc. I also got to help the nurses with patients. Just some basic needs, like getting them some new linens, gown, food, etc.
Summer came and I was going to float around in many different units for two hours a day. My summer schedule consisted of Surgery/OR, Telemetry, Oncology ICU, Hemodialysis, and General Medicine, along with relieving the popcorn lady during her lunch.
In the surgical unit, I got to see how nurses prepare patients for procedures, observe a surgery or two when time allotted, and see patients recover from their procedure. This was where I knew I didn't want to be a surgeon. The thought of cutting someone open, not my thing. It's not the blood, or seeing the organs; I'm not disgusted by that at all. I've seen worse.
Oh tele, a mixture of a step-down critical care unit and general medicine floor. I enjoyed my time here, well enjoyed chatting with the nurse manager who was very helpful in answering my questions as to what a nurse does on a daily basis.
Dialysis, this unit was an inpatient dialysis unit/ ICU. It was for the critically ill patients who needed to stay on the unit and could not be placed anywhere else. Couldn't do much on this unit since it was ICU. Didn't have a call light because there are two patients to one nurse. Telephone didn't ring too often because they are equipped to handle the sickest of the patients and they have standing orders. Carts were stocked. Well I spent most of my time observing the nurse take care of her patients and comforting those who asked.
General medicine, not too shabby as they say. It wasn't wow or dull. It was mediocre. I answered telephones, call lights, faxed paperwork, made new charts, hunted down nurses, passed out food/drinks/blankets, and whatever else they needed me to do.
Here comes the good part, summer has ended and official college is starting for me and I asked to be placed in the Emergency Department. Boy was I happy to finally be able to see how a real ED operates. My coordinator approved my transfer to the ED and I immediately went down there to walk around and observe the unit. I introduced myself to the clinical supervisor, who was excited to have me there as much as I was excited to be there. I would be there on Saturdays from 9AM-7PM. I started out in the front desk (triage), putting arm bands on patients and taking them to the back. They progressively gave me more tasks as time went on and they began to trust me. Next came access to the computer system to know where each patient is going, what meds they are on, what the orders are, the charting, etc. Of course my HIPAA training came into effect. I had to be responsible with the information I have access to. Now, I am able to scribe/chart for nurses, take vital signs, assist nurses more, etc. This is my calling and I'm going into Emergency Medicine.
I call this the first day of official volunteering, I was placed in the new Cancer Hospital on an Oncology ICU unit. I was introduced to the unit secretary and the nurse supervisor. Then I was placed in the nurses station to answer telephones and call lights, fax orders, make new charts, input orders, etc. I also got to help the nurses with patients. Just some basic needs, like getting them some new linens, gown, food, etc.
Summer came and I was going to float around in many different units for two hours a day. My summer schedule consisted of Surgery/OR, Telemetry, Oncology ICU, Hemodialysis, and General Medicine, along with relieving the popcorn lady during her lunch.
In the surgical unit, I got to see how nurses prepare patients for procedures, observe a surgery or two when time allotted, and see patients recover from their procedure. This was where I knew I didn't want to be a surgeon. The thought of cutting someone open, not my thing. It's not the blood, or seeing the organs; I'm not disgusted by that at all. I've seen worse.
Oh tele, a mixture of a step-down critical care unit and general medicine floor. I enjoyed my time here, well enjoyed chatting with the nurse manager who was very helpful in answering my questions as to what a nurse does on a daily basis.
Dialysis, this unit was an inpatient dialysis unit/ ICU. It was for the critically ill patients who needed to stay on the unit and could not be placed anywhere else. Couldn't do much on this unit since it was ICU. Didn't have a call light because there are two patients to one nurse. Telephone didn't ring too often because they are equipped to handle the sickest of the patients and they have standing orders. Carts were stocked. Well I spent most of my time observing the nurse take care of her patients and comforting those who asked.
General medicine, not too shabby as they say. It wasn't wow or dull. It was mediocre. I answered telephones, call lights, faxed paperwork, made new charts, hunted down nurses, passed out food/drinks/blankets, and whatever else they needed me to do.
Here comes the good part, summer has ended and official college is starting for me and I asked to be placed in the Emergency Department. Boy was I happy to finally be able to see how a real ED operates. My coordinator approved my transfer to the ED and I immediately went down there to walk around and observe the unit. I introduced myself to the clinical supervisor, who was excited to have me there as much as I was excited to be there. I would be there on Saturdays from 9AM-7PM. I started out in the front desk (triage), putting arm bands on patients and taking them to the back. They progressively gave me more tasks as time went on and they began to trust me. Next came access to the computer system to know where each patient is going, what meds they are on, what the orders are, the charting, etc. Of course my HIPAA training came into effect. I had to be responsible with the information I have access to. Now, I am able to scribe/chart for nurses, take vital signs, assist nurses more, etc. This is my calling and I'm going into Emergency Medicine.
Growing Up... It all had to start somewhere!
It all started when I was a kid, I've always wanted to become a doctor. Yes a doctor, because they got to cut people open and make lots of money. Especially after seeing all those episodes of ER and Strong Medicine. Then came Grey's Anatomy. I've always had an interest in the healthcare field. When I was growing up, I was taking many family members to doctor visits and translating medical terminology at age 8. I would have to learn what those instruments were, what many common diseases were, and then explain those things to my parents, aunts and uncles, and grandparents, etc. That was then, and this is now. I now understand and know what doctors, nurses, paramedics, EMTs, etc. do to help make people feel better.
In my high school years (2008-2012), I attended a special program called Early College, which allows students to take many college courses while still in high school. In addition to taking college courses, I took Advanced Placement, Honors, and Pre-AP courses. I'm very glad I had the opportunity to do that. I graduated with my Associate's Degree in Science and on the Distinguished Achievement Program. It gave me a head start towards my BSN and BS in Biology and Chemistry and BBA. Who can say they are 18, and are already in their junior year of undergraduate studies?
*BSN stands for Bachelor of Science in Nursing
*B.S. stands for Bachelor's of Science
*B.B.A. stands for Bachelor's in Business Administration
In my high school years (2008-2012), I attended a special program called Early College, which allows students to take many college courses while still in high school. In addition to taking college courses, I took Advanced Placement, Honors, and Pre-AP courses. I'm very glad I had the opportunity to do that. I graduated with my Associate's Degree in Science and on the Distinguished Achievement Program. It gave me a head start towards my BSN and BS in Biology and Chemistry and BBA. Who can say they are 18, and are already in their junior year of undergraduate studies?
*BSN stands for Bachelor of Science in Nursing
*B.S. stands for Bachelor's of Science
*B.B.A. stands for Bachelor's in Business Administration
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