Can Any RN Be Expected to Perform Emergency Room Triage?

Question

Should hospital supervisors be expected to cover triage in the emergency department when we are short-staffed, if we don't have the training or experience to do so?

Response from Carolyn Buppert, MSN, JD Healthcare attorney, Boulder, Colorado

Here is the situation described by the supervisor who asked this question:

With the continued "tightening of the belt" in staffing, the small hospital I work for is asking that the night supervisor step in occasionally and perform the nurse triage function when the emergency department (ED) is busy or short. I have never been an ED nurse. My specialty was intensive care before taking this job. I feel that supervisors who do not routinely work in the ED should not be asked to perform triage. I seem to be the only one who feels this way and am concerned for my license if anything happens. How can I decline this job function and not be seen as a "whiner"? Otherwise, I love the job and don't really want to change jobs again.

You are justified in your concerns. It is a standard of care that nurses should be educated and trained for the work that they are assigned to do. Emergency room triage is not something that all nurses learn in nursing school. It is the responsibility of the supervisor to ascertain, to the extent possible, that the nurse is qualified to perform the duties required. You are in the uncomfortable position of being the supervisor and knowing that you have no education, training, or experience in triage and don't deem yourself to be qualified.

If you are performing triage, don't prioritize correctly, and a patient suffers, the hospital is very likely to be sued. The defense could be difficult, because it is not the standard of care to have an inexperienced nursing supervisor performing emergency triage. Furthermore, if you are working triage, you won't be able to adequately cover your supervisory duties, so there may be a risk to patient safety in taking you from your usual duties. It is better that you advocate for a solution in advance of the night when there is no one to do triage.

There are several ways to approach this dilemma. You could agree to cover, occasionally, just long enough for an experienced triage nurse to get there, if the hospital agrees to help you establish competency. The Emergency Nurses Association (ENA) has a position statement on "Triage Qualifications." If you perform triage and a patient suffers injury and the hospital is sued, the standard of care for preparation of triage nurses would be judged by ENA standards, among other things. You and the hospital should use this document to determine the extent and nature of your training.

Or, you can help develop a policy whereby the supervisor who is on duty before you starts working on getting experienced triage nurses to come in, so that you wouldn't ever be put in the position of performing triage. Also, you might advocate for the hospital to cross-train nurses in a planned way. The point is to be proactive and to advocate for the hospital to be proactive. Clearly, everyone should be working to minimize risk to patients. I agree with you that going along with it, so as to avoid being a "whiner," isn't the best solution. If you make an appointment with the appropriate hospital administrator, state the problem, and offer a thoughtful, reasonable solution, it's unlikely that you will be seen as a whiner.

There are several documents for you to review, in addition to the ENA position statement, before you make your case. The American Nurses Association has a position statement on the rights of registered nurses with respect to assignments: American Nurses Association Position Statement: Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment.

Read the Nurse Practice Act in your state, and review the Board of Nursing Website, with this problem in mind. If your state Board of Nursing hasn't addressed this issue, take a look at the Texas Board of Nursing's answer to a "Frequently Asked Question" (FAQ) on floating: Texas Board of Nursing FAQ: "Floating" to Unfamiliar Practice Settings.

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Cite this: Can Any RN Be Expected to Perform Emergency Room Triage? - Medscape - Feb 12, 2014.