The Life of a Triage Nurse in the Emergency Room
Rita Busat

As part of our celebration of Nursing Week, Triage Nurse Nicolas Dumont has accepted to share with us what it is like to ‘walk in his shoes’ in the Emergency Department."

Let’s follow Dumont while he describes the Emergency Room experience and explains what triage means.

“Triage is the French word for ‘sort’. In hospitals the purpose of triage is to prioritize care for patients so that the sickest patients are seen first. The Emergency Department (ED) does not function on a ‘first come first serve basis’,” Dumont explains. “A patient’s first contact in the ER is with the triage nurse, a highly educated Registered Nurse (RN) who will begin evaluating the patient using the Canadian Triage and Acuity Scale (CTAS).

Following an interview with the Triage Nurse, you will be given a priority of either Level 1, 2, 3, 4 or 5 with 1 being the most severe and life threatening and with the level of urgency becoming less as you move to level 5. The Hawkesbury and District General Hospital follows the Canada-wide CTAS guidelines, ” he adds.

Registered Nurses are trained and educated health professionals who are genuinely concerned about your well-being. But, as we learn from Dumont, it is not always easy to work as an RN, especially in a busy ER. The shortage of family doctors has an impact on ER visits and the nursing shortage across Canada has meant that the nurse you meet today has had to work more than average hours. For example, at the hospital in Hawkesbury, there are about 34,000 ER visits per year. In the past month of April there were a total of 2,606 visits or about 90 visits per day on average.

The ER can be a very active and noisy place where a variety of people with a host of conditions are seen and treated by medical and nursing staff. “The triage nurse relies on accurate information obtained from patients. He or she will create an atmosphere of trust while asking you a lot of personal questions, which will not be discussed with anyone else except the professionals who will attend to you,” says Dumont. “The range of situations and emotions that a triage nurse will go through in one shift is truly amazing! After interviewing fifty plus patients on some days and assigning them a CTAS level, the triage nurse will be in communication with treatment staff checking if a room is available immediately for a patient or asking patients to return to the waiting area.

Triage involves ongoing communication with patients regarding priority of care and treatment and reassessing waiting patients until they can be seen by a doctor,” Dumont adds.

Staff in the Emergency Department appreciate the patience and understanding of patients and their families who experience longer waits. At the same time, we recognize that everyone is pressed for time and many people have hectic fast paced lives. As Dumont says, “Let’s face it, coming to the ER might not have been exactly in your plans for today!”

So, what can both staff and patients do to help improve the ER experience?

“If you have a level 5 designation, your case is not urgent, and it is important to understand that sicker people will be seen before you. It means you will have to wait to see the doctor, which doesn’t mean that you will not be seen or treated.”

“It’s okay to inquire if your name is coming up and it is entirely appropriate to ask the nurse to estimate when you will be seen. It is especially important to tell the triage nurse if your symptoms have worsened. The triage nurse will re-evaluate each case as you are waiting to see the doctor. The nursing personnel does the utmost to lessen the waiting times and cannot be blamed for the length of time one has to wait, particularly if the waiting room is filled to capacity or when very urgent cases arrive by ambulance,” says Dumont.

“The triage nurse will guide you through the ER. In order to give you the best care, it is important that you give accurate information no matter what it concerns. We know how embarrassing it can be to have to remove your clothes for an X-ray or for a physical exam by the doctor. We value maintaining your dignity and privacy throughout your visit. That’s why we show you to an examination room and ask you to keep the door closed. We have not forgotten about you. Don’t open the door to signal to staff that you’re not being seen quickly enough. Do open the door if your situation has changed” says Dumont.

“The triage nurse will do everything possible to make you feel cared for. He/she is equipped to deal with your situation. If a nurse is pleasant, polite and professional with you, you will want to be the same with him or her, right? ”, adds Dumont.

We hope that we have been able to enlighten the public about how the ER works and how it can work better for all! My colleagues and I are truly committed to working with the community and the people it serves as partners in care.