Thursday, July 15, 2010

Is it just me

...or does everyone else in ER despise triage. When I say despise, I mean despise. In the word of my brother, " I hate it. I wish I could hate it to death." A quick explanation for those who don't work in ER, triage is the god forsaken hellhole where you go and sit in a box and see people for the first time when they come in. You collect their information, you take their vital signs, you listen to why they came and then you decide whether you're impressed by their complaint. If you are, you call your charge nurse and try to convince him or her as to why this person might possibly die if left in the waiting room. If you aren't excited by their symptoms, you tell them as tactfully as possible that no, you actually aren't dying right now but you might die later, so go ahead and have a seat out there for a while. No, I don't know how long.

For a while there, I seemed to be the new person to stick up there. You have to have a year of experience and take a stupid class, although I was getting stuck up there pre- stupid class. For whatever reason, I seem to be the only person in my internship that gets put there- they've oriented another friend of mine but she hasn't ended up there yet. Different story for me I'm afraid- and unfortunately, my night to go to triage seems to be Sunday night, the busiest one out of our week. I guess I should be flattered that they trust me enough to do the job, but every time I go I seriously feel like I'm being punished. I can't tell whether it's just me or if this is truly the most terrible job in the entire world, but here's why I hate it, in a handy numbered list:

  1. The Drama. Hooollly crap. You don't know drama until you've been to triage. Especially at hood hospital. Our wait times, on a good day, are about 2 hours. On a decent day, it's about 6. The worst I've seen it was 16. Naturally, no one wants to wait that long. So what can you do? Give the performance of the year in the triage booth, and then try to earn your lifetime achievement award in the waiting room. Wretching loudly in order to bring up what is essentially a loogie is an old favorite. Wheeling around in a wheelchair when you don't need one is also popular. My personal favorites are fake syncopal episodes or fake seizures, which are pretty quickly cured with a good sternal rub. Of course, when all that fails, nothing beats sliding onto the floor and rolling around while moaning. If it doesn't get you back to a room faster, at least the academy will love it.
  2. The Hatred. I work with lots of people who can get cussed out by a patient and not bat an eye. Let me just say I am not one of those people. No matter how much of a front I put up or how much of a crazy asshole the patient is, it still hurts my feelings and I do still take some of it to heart. The likelihood of having something awful said to you increases to the millionth degree when you're up there. It's almost as if everyone assumes you aren't actually trying to help them, but you're just trying to keep them waiting longer. From what I can tell, your attitude makes no difference. I triaged an elderly hispanic lady the other day whose daughter had checked her in for nausea and vomiting. We were packed that night, and literally every room was about to be filled with ambulances. The lady was fine- a little dramatic but not the worst I've seen. Her daughter was a douchebag. She's telling me a bunch of crap at once, despite the fact that mama is totally capable of talking herself- that's minus some points right there- but keep bringing up the fact that her mother is a diabetic. I am sweet as possible to them, I get mom a Zofran tab, I get mom a blanket. I tell them I am very, very sorry but there are lots of sick people here today and we physically do not have a room right now. "Not even for a diabetic?" she asks me in a tone that actually means "Are you effing stupid?" This is after she has told me that she thinks her mom is just sick because they ate Mcdonalds and her system wasn't used to it, and showed me a full bottle of Phenergan that no, they didn't try using because we can give medicine in the ER. When I told her a lot of our patients are diabetic and diabetes does not guarantee you a room, she gets on her cell phone to update the rest of the family- she's speaking Spanish but I hear her drop a key word -"perra". Oh yeah, okay. Listen lady. I don't even speak Spanish, but I know you just called me a bitch. But I guess that's okay behavior since I'm just the mean, stupid triage nurse, right? The death glares I get from people I've sent out there every time I get a new patient to triage and the general level of hostility in our waiting room is a whole other post, so I'll just mention it here briefly.
  3. Pediatrics. Children scare me. I swear triage is 50% children, and half of their parents leave with them before being seen. This means I see a disproportionate amount of sticky little people who move all the time who scream and kick and are impossible to get vitals on. Side note: I don't hate kids, I just hate taking care of kids.
  4. Boredom/Loneliness. Part of the thing I adore about my job is team nursing. I get to work with a group of people and we have fun together and help one another. Supposedly, there was a day in time that there more than one nurse in triage. I'm not sure I believe it. Kind of like how we were going to have a second triage nurse at all times for about 2 months now. This means if 15 people check in over a period of 30 minutes like they like to do, you better just work faster, because there is no one to help you. This also means that you better have a good book up there if it slows down, because there is no one to talk to and management took away the one perk of triage- Minesweeper. Bastards.
  5. Stupidity. I always thought there was some stupid people that came to the ER my first year as a nurse. Turns out I had no idea. The things people check in for and leave before waiting to be seen are mind blowing. Who would've though that someone would go to the ER, get a prescription for Elimite to treat their nasty scabies, and then check back in for the same scabies a few days later because the prescription was more that you wanted to pay and you insist on having your scabies treated at the ER. Really? I swear a die a little inside every time someone checks in for something like this.
I'm sure there's more, but just talking about this makes me tired and a little sad. I'm gonna go get a beer and see Inception now.


  1. Ugh. I recently got the email from my manager which read "Congrats, Shrtstormtrooper! You're going to be taking the triage class in August, isn't that EXCITING!?" Um, no. No it isn't. I want to die inside every time I even think of triage. And for a few weeks there, someone scratched off the word "triage" on the assignment sheet and wrote "tragedy" instead. Sigh. It won't be pretty.

    ...Also, Inception! What a fabulous movie.

  2. I love triage, once in a while. I get to have a down day sitting on my butt and drinking diet cokes. There is one full-time triage nurse who works Fri,Sat,Sun and her ass has gotten so huge since she started out there. Not to mention she's totally nuts. Once a month for a shift is fun. I like to smile and agree with all the crazies while I make them a level 4 or 5. hahaha.

  3. Not to sound like a bad person but I think a large part of the problem is the mentality of the people you have to deal with. That "street" or "entitlement" mentality which you can't overcome. People should try to help other people however there are some who are just absolutely worthless. Keep up the good work!

  4. Bahaha. Tragedy. I love it. My plan has been to be a massive pain in triage and bother the charge nurse about everything, so that maybe he'll stop putting me there. We have a weekender who works only triage, too. I don't get it. I would end my own life if that was the only part of nursing I had to do.

  5. The poor triage nurse in the cubicle at our hospital got attacked and beaten it is a locked area. They won't even let you talk to a nurse until you check in first with your name at the admit desk - where I swear they look you up in the police records first. I had to wait 6 or so hours for my gall bladder pain. I was ok to wait (read my little blog on it! hahaa!) and mostly it was an orderly wait room. On another a phone triage nurse...we try and keep a lot of those described types out of the ER. And no one would get away with requesting scabies treatment in ER. They would be discharged immediately with a "no way". Sheesh.

  6. Luckily for the triage nurse, most of the physical violence seems to be directed at the first look medic. One guy got choked, and another got a cell phone thrown at him. There is actually a "no cell phone throwing area" sign posted at our check in desk now. People are crazy.

  7. Para in Spanish means FOR. :) Maybe she was just saying Para. Cabrona means bitch.

  8. Possibly. This is the same woman that when she got back to a room with her mom said to the nurse taking care of her, "It took really long this time. Next time I'll just take an ambulance", so either way I'm sticking with douchebag.