Tuesday, June 13, 2017

The Triage Nurse's Role as a Detective

A skilled triage nurse knows that every call he/she receives should never be taken for face value. So many times the initial complaint may be one symptom and turn out to be something completely different, and potentially serious.
Here is a good example of this. The initial message from the answering service came in as infected bug bite. The nurse, being as diligent as she was, pulled up the insect bite protocol, and returned the mother's call. The mother stated the child had an insect bite for a couple of days and was showing symptoms of infection. The child was complaining that morning of not feeling well. The mother is a diabetic, but the child had never had any diagnosis so the mom decided to check the child's blood sugar just to see and it was over 300. Now the call had just taken a 360 degree turn. It had gone from what seemed simple, and could be treated the next day in the office to an immediate emergency room referral.
This situation would be a good example of the skill and expertise that is needed to be a triage nurse, and why unlicensed personnel should not be in this role. It also requires a variety of experience to be able to recognize that the biggest problem was not the insect bite, but the child could potentially be an undiagnosed Type I diabetic. It also then takes knowledge to know where to locate the correct protocol and chose the correct plan and disposition.
An experienced triage nurse knows what assessment questions to ask to determine the issue at hand, and has excellent listening skills to be able to determine if a small bit of information elicited from the caller could be something that needs to be investigated further. They interview, investigate, listen to the caller, listen for background noises that could potentially help, such as the quality of the cough from the child that the parent could be calling about, and then, they are able to take all that information and determine a plan that is the safest and most effective for the patient.
Being a skilled triage nurse means being a skilled detective.