To the Triage Nurse

To the Triage Nurse,

Triage is where you assess patients and work out what they’ve come to hospital for and how urgently they need help. You do this by doing obs, asking questions and observations you make yourself. Speed is essential because there’s always a busy waiting room of patients and you probably get moaned at a lot for the amount of time people have been kept waiting.

It can also be stressful for us as patients. If you don’t go to hospital very often, it’s the first contact with someone medical. You have to try to explain your problem and you’re not sure what information might be relevant. You’re worried about whatever it is that has made you feel the need to go to a&e in the first place. Calm and reassurance is definitely needed at this point, as well as efficiency, because it sets the tone for how the rest of the time in the department goes.

As a chronic illness patient, triage is also where I make my own assessments. I go to hospital relatively frequently and know that if the triage nurse is ‘on your side’, then it makes life a lot easier. While you’re checking my heart rate and bp, I’m watching the way you respond to it, either by what you say to me or what your body language says to me. When you ask me questions, I’m paying attention to see if you’ve heard of my rare illness and know what it is or if you’re glossing over it because you don’t think it’s important. I’m deciding whether or not I need to start arguing or if you’re going to be an advocate for me.

The other day you didn’t know what my illness was but you didn’t dismiss it. You listened to my explanation of it, did my obs and said you’d ask the consultant for advice. I told you how I’m not a textbook case and that my bp goes up when I’m sick, not down, and you said you’d mention that to him too. I don’t remotely want to ‘tell you how to do your job’, but I’ve been here before and know what’s likely to come up. You took me seriously and I knew that you were going to look after me.

Sometimes the triage nurse is under pressure and just looks at my numbers and decides I’m ‘not that bad’, not taking into account that I’m up against a clock and things can go downhill fast. Other times they’ve seen so many time wasters that day they’ve become really cynical of most things. I usually look ok and sound ok and am pretty articulate, but mostly only because I’ve been there so many times before I know the routine. Occasionally, I have to get my emergency injection out and ‘threaten’ to do it there and then in order for the triage nurse to see that I’m not being melodramatic and I’ve been given life saving drugs for a reason. If I’d been triaged properly, I wouldn’t mind, I only do that when I know I need help fast. Doing the injection before having bloods taken can skew some tests, so if I’ve managed to get myself to hospital without doing it, the tests should be done as well.

Last week you were great. My heart always sinks a bit when someone asks me to spell my illness and doesn’t understand how much hydrocortisone I take. But you weren’t afraid of asking for advice, even with your student watching. You advocated for me to the consultant and got me a room quickly with minimal fuss. You communicated to me what you were doing at every stage, all in a calm and controlled way. You set the tone for my hospital admission well: I felt looked after from the moment I saw you, even when some things did get forgotten in the bustle of a busy department- you and your student nurse checked I’d had my meds when you saw me in the corridor and sorted it immediately when I said I was still waiting.

Triage might be the least contact a nurse has with a patient during their time in the emergency department, but it can be a really powerful and meaningful interaction for us patients. Thank you for not just doing your job efficiently, but also doing it effectively.

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