How a nurse can help you perform triage

Some clients come to you in a state of financial emergency. But how do you dig beyond the obvious symptoms to find the cause of their financial distress? And, if there are multiple causes, how do you know which one to tackle first?

We ask ER nurse Marissa Weiler, who triages patients at Greater Toronto Area emergency rooms, how to assess and prioritize.

Problem: How do you make sure you’re not just addressing the symptoms of an underlying issue?

Solution: Weiler’s most said phrase as an ER nurse? “If you really want me to do my job, you have to tell me everything.”

She adds, “For the patients who have swallowed something strange [but] don’t want to admit to anything, their chief complaints will be something like bathroom difficulty.” So how do you get at the real issue? “I say, right off the bat, ‘I’m not here to judge, and in order to give you proper care, I need to know these sensitive details,’” says Weiler.

They’re likely embarrassed, so it also helps to let them know they’re not the first to wind up in this particular bind. “I always let them know that I’ve probably seen and heard worse,” says Weiler.

Problem: A client comes in with a long list of critical concerns or goals. How do you determine which are the most important?

Solution: Numbers don’t always tell the whole story. After a head-to-toe visual assessment, the first thing a triage nurse checks is a patient’s vital signs, explains Weiler—but they can be misleading. “You’d think high fever equals sick. But if you have a low temperature, you could [also] be sick.”

3 tips

1 Get crucial information about the client’s financial state by showing him it’s safe—and necessary—to tell you intimate details.

2 Refocus him on recent events to assess which issues are most critical: What prompted him to make this appointment?

3 Don’t let his panic make you panic.

For example, a patient with sepsis (a condition that can cause several organs to shut down at once) can have a low fever, even though the condition is traditionally associated with someone who’s burning up.

The only way to properly triage is to ask the right questions. Some people will live with a condition for months before seeking help, so Weiler tries to refocus them on the last 24 or 48 hours. “You have to ask, ‘What’s making it different today? What made you come in?’ ” she says.

It also helps to find out about their personal lives. “There are things people wouldn’t necessarily think to mention,” says Weiler. “If they’re coming in with back pain, I ask ‘What do you do for a living?’ If you do a repetitive motion or stand all day, it could be a factor.”

Problem: How do you comfort a panicked client?

Solution: Find out what led them to come to you in a state of emergency. Sometimes, it’s not strictly because of the immediate problem at hand. Weiler adds, “Some people find relief just knowing somebody cares enough to ask the difficult questions.”

And, in the case of a truly panicked patient, Weiler says to stay composed. “I tell them, ‘I’ve got a job to do. I can’t do it if you’re having a conniption,’ ” she says.

by Mira Shenker, a Toronto-based editor and writer