You Don’t Want to be First
Being a triage nurse is like being a nightclub bouncer. They are the first medical professional to see patients as they walk in. From across the room, they must evaluate the severity of their illness or injury, often while talking with another patient. Triage is a game of measuring vital signs and documenting chief complaints while constantly listening for something more serious in the waiting room. The triage nurse is the gatekeeper of the department; deciding who gets a bed first and who must wait.
Often, the triage nurse must investigate. Sure, the patient says they have back pain, but that’s a subtle sign of a heart attack, too. Is that a simple spider bite or a worsening bacterial infection? The triage nurse must quickly analyze vital signs and evaluate symptoms to determine the root cause of the patient’s problem. They can’t just trust what the patient says, they must use their knowledge and experience to identify how sick each patient is and compare that to the other waiting patients. They do all that, screen patients for sepsis, and calculate patient severity scores, all while maintaining order in the waiting room.
Ideally, ERs would always reserve at least one bed (called the “code blue” bed or, less eloquently, the “oh shit” bed) for incoming life-threatening emergencies. With overcrowded ERs though, sometimes even that bed needs to be used. Because of this, people with non-life-threatening medical complaints wait for hours just to even get inside the ER.
Do you know why it takes so long? The ER is a linear process; each step must be completed before the next can begin. First, you have to be registered, then you have to be triaged. Based on how sick you are, you’ll then either wait in the waiting room or you’ll be taken inside the ER.
Once inside, your journey may differ depending on what’s wrong with you, but I’ll generalize what happens next. When your nurse is available from dealing with their other patients (who may be sicker than you and take up more time), they will start an IV and draw your blood and ask you to provide a urine sample. If you don’t have to urinate, your diagnosis will be delayed until you can.
Then, the provider (physician, NP, or PA) will evaluate you. They may order more tests and/or medication. At this time, you can be taken to get x-rays or CT scans. It takes around an hour for the lab to run all your tests. It takes the same amount of time for the radiologist to read your x-rays and CT scans and write a report about them. Your nurse will come by eventually and give you your medicine.
Remember, the nurses are dealing with at least three other patients who all are fighting for their attention. The patients all want blankets and water and to be readjusted in bed. They all have IVs to start, blood to be drawn, and urine to collect. Sometimes they need to be cleaned after they soil themselves. Sometimes they need to be wheeled to the restroom. Sometimes they need to be intubated or have CPR started. Sometimes they cry and need their hand held. Sometimes they’re crazy and physically fight us. Just know this: things in the ER take time and your nurse is working hard to get the most critical things done first. Of course your abdominal pain matters, but giving you pain medicine doesn’t take priority over giving heart medicine to the patient trying to die on us next door.
Once all your lab and radiology exams have results, the provider will be able to formulate your diagnosis. At this point, they’ll decide if you need to be admitted to the hospital or get discharged home. Being discharged requires typing and printing your paperwork, removing your IV, and getting you out the door. Then, the room must be sanitized and made ready for the next patient. Being admitted takes longer and involves consulting with another provider to accept your care and then transporting you to a bed upstairs once it is available — assuming one is available; otherwise, you’ll just stay in the ER, taking up a room.
I explained all of this because it is important to understand why getting patients through the ER takes time. Because of this, new patients are forced to wait in the waiting room until someone else is finished with that entire process before they can be placed in their room.
However, if a patient walks into the waiting room with a life-threatening condition, they must be brought back to the ER immediately. The nurses will have to do something to accommodate the dying person, like moving another patient out of their room and putting them in the hallway.
Being the priority patient in the ER is not a good thing. Maybe you’re having a stroke or a heart attack. Maybe you’re having an anaphylactic reaction or a fatal drug overdose. Whatever it is, it’s serious.
Making a seasoned triage nurse jump into action does not happen lightly. Seeing them panic is indicative of a serious problem. Those nurses have seen everything. They learned long ago that crying or screaming the loudest does not equate to being the sickest. After all, if you’re screaming, you’re breathing.
So, if you’re ever in the ER and want to complain that it’s taking too long or that other people are being taken back before you, remember this: those people are sicker than you. You don’t want to be the patient who gets taken back first. You don’t want to be sick enough to make the nurses run. Be thankful that you can wait.
We know it’s boring. We don’t like making you wait. Trust us, if we could speed it up and get you in and out quicker, we would. We don’t find joy in keeping you longer and wasting your time. We want you to go back to your life just as much as you do.
We try new techniques and do whatever we can to streamline the whole process. We even have a word for it: throughput. We have meetings to strategize optimizing it. However, we can only speed it up so much. It just takes time for the lab to run your blood. It takes time for the pharmacy to mix your medicine. Everything takes time.
If you see us laughing with each other, understand that this is our workplace. Don’t take it as us goofing off or joking while you’re in pain. It’s not like that. We just have to be able to cope, too.
Please give us a break. We’re tired. We’re overworked. We’re understaffed. We get assaulted and mistreated. We are asked to do too much with too little. Be thankful that you’re not sicker than you are, and bear with us while we work as quickly as we can to make you feel better.
David I. Mancini is a Registered Nurse and a Licensed Paramedic. He’s a tech enthusiast, world traveler, and an eclectic eater. https://davidmancini.xyz
