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Triage is a tricky area in nursing. People will come into the triage area and tell you, the triage nurse, about their health problem and then tell the doctor something totally different. The skills you need are not difficult to learn, but your assessment skills need to be top notch! As a triage nurse you are always assessing everything about the patients, breathing, speech, gait, skin, vital signs, how the patient acts in the triage chair, etc.
The patients are usually frightened and in a hurry. They can either be timid, loud and unsure what to say or how to say it, or they can be aggressive, demanding or entitled.
The patient I would like to tell about in this story is one who was aggressive and violent. His fuse was so short before he left he had the Boston police chasing after him. This is a true story of what it is like to be alone in an area like triage that is full of people.
One Nurse's Story
Just a little background information - the triage I am writing about is right there when the hospital doors open. People come right to the window. There is a note in English for patients to write their name, time and complaint. There is also a place for patients to check if they are 18 years of age or younger.
None of this is difficult for a patient to do (except if he doesn't read English; can't read; has a hand injury; is unable to see; or has a host of other issues). However the slips are seldom filled out properly. This particular person wrote on his slip "I have a runny nose and sore throat."
When the nurse called him into the triage office, she invited him to sit down, introduced herself and asked why he was here. He immediately got angry, stating "read the slip."
With this statement, the nurse explained she needed more information and asked him to sit. Before the patient sat down, he put his hand on her shoulder and pushed her. He was yelling and swearing, and then he sat down. The nurse picked up the phone and called security to standby.
The patient was still sitting in the chair. "You called security on me?" he asked. His voice was loud and intimating.
Call for Help
The nurse, already assessing the situation, made her move out of triage and into the waiting room that was full of people. She crossed over to the registration desk. Now she felt she wasn't locked in the triage area. Security hadn't arrived yet.
The patient was still yelling, but no one in the waiting area paid any attention. The nurse needed everyone to be safe so she picked up the phone at registration and called the Boston police.
When she went to turn around and go back to the patient, she realized he was standing right behind her. He yelled, swore at her again, and spit in her face. The waiting room was packed with patients and family members. Security was arriving and the patient left running out the front door. The Boston police arrived and spoke to her.
The nurse continued her shift in triage until someone relieved her. When she was relieved, she realized how shaken she was. Many thoughts went through her head: the first being the danger she felt for herself and her coworkers, patients and families. She started to wonder about the "what ifs" - what if he had a knife, a gun, etc.
She knew a decision had to be made. She felt intimated, feelings of fear, disgust and the reality no one was helping her.
"I was alone in an area that is full of people," she said. "Being spit on is absolutely gross. The feeling of having someone's saliva running down your face isn't a happy feeling. Also when I looked at him and he was smiling and laughing. His emotion to want to do harm was really strong."
Having spit on her face, with the eyes, nose and mouth as open areas, the nurse began to worry.
"I am educated enough to know the saliva is very low on the list of contacting HIV or hepatitis C, but what about MRSA?" she wondered. "Is this part of my job? Can I go anywhere else and spit on someone and get away with it? Many questions are in rapid fire after you have been assaulted. If you are not in a place that will help, it could end up being disastrous."
Who to Turn to?
As the nurse thought more about what happened she remembered the police were called but were not present when the patient pushed her, swore at her, then spit on her; so she didn't think they'd be able to arrest him. All of these questions were running through her head as she was scrubbing her face so hard it was bright red.
She knew this wasn't part of her job even though some people would scoff at this, but this is a major injury to someone. The feeling of being safe and secure on her job was now shattered.
When something like this happens, you really understand bad things do happen to good people. You realize the workplace doesn't uphold its end of the bargain to make it a safe place. You start to think about what the Occupational Safety and Health Administration (OSHA) really does.
OSHA's mission is to prevent work-related injuries, illnesses and deaths. Since the agency was created in 1971, occupational deaths have been cut by 62 percent and injuries have declined by 42 percent. Can they hold the place responsible for this or will it get chalked up to "I am sorry this happened, but I am sure you must have realized it is part of the job."
You decide to move forward and this means going to court. So who helps? The union? The hospital? In reality no one is going to help you go through this ordeal. Is anyone really interested in you as an individual? Is it true all the institution wants is a warm body to work? Is it true the union only wants someone to pay union dues?
I believe if we as nurses don't stand up and speak out for our safety, it will continue to be a dangerous job. A job where you can lose your license. We all know when a patient loses control, you get distracted. And that's when errors are made.
If we choose to do something, we should band together, for each other, our patients and their families. Call your state representatives. Tell them we need protection and pass the bill making it a felony to assault a healthcare worker.
Sheila Wilson is a nurse at Caritas Carney Hospital, Dorchester, MA, and at the Massachusetts Eye and Ear Infirmary, Boston.
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