Triage according to Katie

Every patient who comes to the ER is triaged when they first
arrive. When triaging a patient, a complicated formula is used to determine
what "level" to make that patient. Here is my own version of our
levels:
Level 5 – should have gone to a pediatrician’s office- send down hall to First
Care
Level 4 – same as level 5, but higher priority than level 5
Level 3 – stable for now, keep close eye on
Level 2 – kind of stable, requires a lot of work, could go downhill any minute,
send to Katie’s room
Level 1 – trauma, life or death situation

I don’t know why, but for my last few shifts, all of my patient’s have been
level 2’s. The first few days I handled things without too much difficulty, but
on Wednesday, I was put in the Asthma room. The Asthma Room is a little taste
of Hell. It is a small room with seven reclining chairs lined up against the
wall. There is one nurse responsible for all seven patients, and unless there
is a trauma in the back, there is a respiratory therapist there as well. That’s
right- a seven to one patient to nurse ratio for children having TROUBLE
BREATHING! For those of you who are not medically inclined, a patient’s airway
is the most important factor in keeping patients’ alive, and children are known
to go from respiratory distress to cardiac arrest in just minutes. Any one of
my seven patients could quit breathing. When I am in the asthma room, I feel
like I am holding my breath the entire time. Just keeping up on the hourly
vital signs for seven patients keeps me busy- but then there are meds and
admission papers and nursing notes and PARENTS to deal with. When I find out at
the beginning of the shift that I am in the Asthma room, I say a little prayer
asking God to give me the strength not to cry until I get to my car at the end
of the day. Wednesday I barely made it to my car before the tears started
flowing. I forced myself to return to work on Thursday, and was given a normal
room assignment. Thankful that I wasn’t in the Asthma room, I thought I was
going to have a good day. I was wrong. My first patient was supposed to be a direct
admit to the floor, but they didn’t have any rooms available, so I had her for
six hours. She was on a ventilator and was having difficulty breathing. Then
they brought me a "Level 3" who ended up being admitted to the ICU,
except there were no ICU beds available, so he stayed in my room. My next
wonderful surprise was an autistic child having seizures, two of which he
demonstrated for me in his room. When he started seizing, all I wanted to do
was leave and never look back. How can I handle these three patients at the same time? I barely made it through the day without losing
my mind. I guess I was hoping that they would save the severe patients for the
more experienced nurses, but that is not how things are going to work. So here
I am now, nervous about going to work, but somehow loving it at the same time.
I know that I will get through it and am thankful that I have found a few
experienced nurses that I can turn to for help. For now, I am keeping my
fingers crossed that I start getting a few more Level 3’s my way, but that I
will be able to handle the Level 2’s I am somehow destined to get. At least the level 2’s make for good stories, as soon as I get the energy to write them….

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11 thoughts on “Triage according to Katie

  1. Katie,
    I think I would have felt just like you did except I would have passed out!  Sounds like the ER never has a dull moment.  I am getting ready for finals this week and am happy that I stopped in as your experiences help me to think of how "real" nursing is.  Keep up your confidence and keep smiling, and don\’t forget to breathe!
    🙂  Eve

  2. It looks like someone or something (God, perhaps?) is testing you!  Remember: what doesn\’t kill you makes you stronger.  😉
    I often wondered about the triaging thing–it\’s a mystery to us \’non-medical\’ people.  Last year I took my boyfriend to the emergency room because of his appendix.  I guess I don\’t need to tell you how painful it is when your appendix burst–ouch!  Anyway, we sat in emergency for almost three hours!!!  He was out of it but I was paying very close attention as to who was admitted before him.  A guy with a cut on his finger came in after us and was treated 10 mins later!
     

  3. Ahhhh!  I held my breath while reading the blog!!!  Any kind of unable-to-breathe situation is awful…  And dealing with parents?  I mean, it has to be done (I\’d want to know what was happening with my child) but that time takes away from the actual treatment process….  I don\’t multitask well enough to handle that kind of thing–gracious!

  4. perhaps they give you the level 2\’s because they know that they gave it to the best nurse there… or that you can handle it with care and compassion because the other nurse/s are crabby and mean….
     
    you are wonderful….give yourself some credit katie…. you would ROCK as my nurse or my children\’s nurse.. i\’d request you even if it wasn\’t your specialty…. :o) just because i\’d know you care… or do really well at pretending!!!! 😉
     
    have a good one or at least try to…. :o)

  5. All these level 2\’s are just breaking you in…an informal nursing initation.  Some day, you get all the above in the same day and at the end of your shift, you will be like, wow, what a boring day! 

  6. I\’m sure you are not the only nurse or even doctor there that feels like they could just totally lose it by the end of the day.  The fact that you keep going back proves that you are a strong person, very suitable for a job like you have!  You can do it!God bless 🙂

  7. I was thinking of what I was going to say in my comment to you as I was reading your blog when suddenly..you said..what I was going to say. You leave crying, you don\’t think your cut out for this, doing a good job etc..but at the same time..You feel exhilarated and awe struck. It\’s werid! Yet..I only did that stuff in Clincials your out doing it in the real world.  I must admit..reading your blog today makes me want to go back and get my continuing education credits to take my boards. I love burning the candle at both ends like that!

  8. Wow…I thought I was having a bad day…you beat me by a landslide…my hat\’s off to you…Keep going, God\’s walking with you…It\’s like the Footprints poem…if you don\’t know, I\’ll send you a copy…let me know.

  9. Kiddo, seems like you\’re experiencing "future shock" in overdrive. Are you still in orientation? Seems like you should get 6-8 weeks depending on the hospital. I hate to say it but it seems to me  that you are getting a true "initiation by fire".Sometimes in the nursing profession , young nurses are baptized by giving them all of the difficult patients. This makes it extremely difficult to develop prioritazation skills. The shift in the asthma room is just that, you should never be there by yourself. 7-1 ratio is never a good thing esp. in ER. I\’m not sure the staffing ratio in your ER, but sounds like they are short staffed. This is a common problem in hospitals now and doesn\’t seem to have a end in sight.Hang in there and don\’t be afraid to ask for help when you are overwhelmed, that\’s what your preceptor is for. Even after orientation is over your preceptor remains your resource person. Don\’t accept assignments that don\’t seem safe to you…because if you think you\’re " over your head"…you probably are.      Nurse Bill

  10. Whoa, you sound exhausted. Seeing as you hadn\’t blogged in quite a while, I can see why. I\’m starting orientation in February and I was wondering, will this happen to me on my first month on the floor? Scary. I always assumed they would give critical patients to more experienced nurses, but I guess I was wrong. I have a feeling no matter how hard I prepare for clnicals, I\’m going to have a rude awakening. You seem to be holding up pretty well though. Keep it up!

  11. My aunt is a Respiratory Therapist and even though she is trained to work on babies, won\’t. It is just way too depressing for her. It is so much easier to work and see the elderly sick than babies. It takes a lot of strength to work with kids. Your strength is amazing!
     
    😉 Michele

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