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.