EP=Glorified Trauma Nurse?

[LTbulldogs]

I?ve heard people on this board and elsewhere refer to EP?s as glorified triage nurses. Why do people make that comparison? How do EP?s distinguish themselves from that particular nursing specialty?

LT

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[Sessamoid]

Is must that that time of the year again. The trolls are coming out.

 

[Jeff698]

How do EP?s distinguish themselves from that particular nursing specialty? LT

At the risk of continuing this silly topic, I'd say by practicing medicine.

Jeff

 

[NinerNiner999]

Because despite our uncanny abilities to get sick people where they need to go, we actually perform interventions that save their lives (and yes, even yours trollie troll troll)...

 

[la gringa]

and where oh where would a nurse come across a "specialty" such as "triage nurse". they're lining up for that one!

 

[FoughtFyr]

I've heard people on this board and elsewhere refer to EP's as glorified triage nurses. Why do people make that comparison? How do EP's distinguish themselves from that particular nursing specialty?

LT

The same way ID physicians distinguish themselves from a 4th year medical student with a Sanford guide...

The same way electrophysio-cardiologists distinguish themselves from the latest 12-lead interpretation computer...

The same way an FP distinguishes themselves from a school nurse...

The same way a nephrologist distinguishes themselves from a dialysis nurse...

And the same way you distinguish yourself from a bored, pathetic loser with nothing better to do than troll on internet forums, oh wait, you don't make that distinction... my bad.

- H

 

[LTbulldogs]

It was an uncomplicated question, I don't understand the disgust. I simply asked why someone would make the comparison and how the two fields overlap (if at all)? Given the unreceptive responses, I would assume the subject to be somewhat controversial, at very least. Taking into account the hostile reaction, I?ve become even more interested in understanding my original question and also in understanding why I would be considered trollish for asking about where a medical specialty and a nursing field overlap. I don?t believe it to be an uncommon inquiry considering the absolute embarrassment occurring in anesthesiology.

 

[Hernandez]

It was an uncomplicated question, I don't understand the disgust. I simply asked why someone would make the comparison and how the two fields overlap (if at all)? Given the unreceptive responses, I would assume the subject to be somewhat controversial, at very least. Taking into account the hostile reaction, I?ve become even more interested in understanding my original question and also in understanding why I would be considered trollish for asking about where a medical specialty and a nursing field overlap. I don?t believe it to be an uncommon inquiry considering the absolute embarrassment occurring in anesthesiology.

It's not an uncomplicated question, it's a trollish question. so let's start off, with where you're at in your education? I ask because it doesn't seem that you have any first hand medical experience. And the mere comparison of any physician with a nurse is asinine in its own right, the knowledge base gap between the two is substantial.

EP's are in my humble opinion the last purveyor of true general practitioner of medicine, they cover the major fields, cardio, renal, family, surgery, etc. I personlly don't trust NP, PAs, or any other non physician doing a physicians job except on a case by case basis.

 

[LTbulldogs]

It's not an uncomplicated question, it's a trollish question. so let's start off, with where you're at in your education? I ask because it doesn't seem that you have any first hand medical experience. And the mere comparison of any physician with a nurse is asinine in its own right, the knowledge base gap between the two is substantial.

EP's are in my humble opinion the last purveyor of true general practitioner of medicine, they cover the major fields, cardio, renal, family, surgery, etc. I personlly don't trust NP, PAs, or any other non physician doing a physicians job except on a case by case basis.

First, allow me to apologize for completely disregarding the section in the EM Faq?s thread titled, ?Trollish Questions, What Trolls Don?t Want You to Know?. I?ll be certain to review those questions and prepare myself for the future. Secondly, I didn?t compare the two professions, I simply asked where the fields overlap. To suggest that the fields don?t overlap is ignorant, I would assume. Finally, thanks for somewhat answering my question. I am interested in learning more about the role of the NP/PA in the ED compared to that of an EP.

 

[hello23]

It does not matter what field you practice in. If you think like a triage nurse, you ARE a triage nurse. You can still be an internist or even an orthopod to be a triage nurse. Nuff said. LTbulldog, I suggest you shadow an EM physician to answer your own questions.

 

[Sessamoid]

LTbulldogs, it sounds like you don't even know the difference between physicians and nurses yet. Why don't you get that part straight before insulting a whole specialty of physicians?

 

[margaritaboy]

To suggest that the fields don?t overlap is ignorant, I would assume.

Speaking of ignorance, 'triage nurse' isn't really a 'field.'

 

[beanbean]

I'm sorry if you had a legit question and everyone here jumped down your throat, but it sounding like you were baiting people for a insulting EM debate. This is a sensitive issue because some people put down the EM profession using similar language (calling EM physicians glorified techs or nurses) when they are ignorant to what EM docs really do. Doctors and nurses fufill to very vital and very different roles in the emergency department and medicine in general. Although the two professions work closely together to provide patient care they each have an independent approach and focus.

If you are curious about the role of PA's and NP's in EM - that is a different question than what you initially asked. Do a search on this forum - I know is a thread here somewhere that talks about PA's working independently in rural ED's and the issues regarding this.

 

[Febrifuge]

Although I realize I might be feeding a troll, for the moment I'll take you at your word and treat this as a legitimate, UNintentionally bothersome question.

I?ve heard people on this board and elsewhere refer to EP?s as glorified triage nurses.

I have not heard that, nor seen it here. I don't think this is a widespread thing.

Why do people make that comparison?

I have no idea. It's a really loaded - and faulty - comparison to make, and it implies a bunch of really outlandish and offensive stuff about the level of expertise of EPs.

How do EP?s distinguish themselves from that particular nursing specialty? LT

Look, maybe the responses you're getting here make more sense if you think of it in terms of what's between the lines when asking that question: "couldn't a triage nurse do the job just as well as an Emergency Physician?" If that's the question you meant to ask, you're a troll. If you didn't, then your text analysis skills need some sharpening, since that's stuffed with nasty subtext.

The triage nurse sits at the triage desk at the front door of the Emergency Department, and upon a quick eyeballing, a set of vitals, and a brief interview, decides whether a person can wait a little, or needs to see a doctor sooner.

So obviously, the doctor is going to have a different role, since s/he is the "goal" of the process that the triage nurse executes. You don't ask the difference between a talent scout and a college basketball coach, do you? They work together. They're parts of the same larger objective. But to suggest that one could just step in and do the job of the other is really pretty senseless.

 

[RBorhani]

I have been doing Emergency Medicine for the past 5 years. Being an ED doctor is anything but easy. You do have to constantly deal with other specialties. It is a specialty that you could get a bad reputation fast, if you are lazy and not competent in taking care of patients without consulting specialists all the time. In general all the new ed docs, at least all the ones in my group, are anything but "glorified triage nurses".....

 

[OSUdoc08]

I?ve heard people on this board and elsewhere refer to EP?s as glorified triage nurses. Why do people make that comparison? How do EP?s distinguish themselves from that particular nursing specialty?

LT

Don't triage nurses take your blood pressure and temperature, and check of the little boxes on the chart off of what you tell them?

They could probably just stick a tech or CNA up there to do that. Triage nurses don't actually do interventions. Most nurses hate getting assigned to triage because they have to play CNA for the few hours they are doing it.

I suppose if you wanted to compare an EP to a triage nurse you could, but then again, when is the last time you saw an EP taking v/s on everyone in the waiting room?

 

[fuegorama]

I?ve heard people on this board and elsewhere refer to EP?s as glorified triage nurses. Why do people make that comparison? How do EP?s distinguish themselves from that particular nursing specialty?

LT

Sessamoid probably hit it on the head here. I don't think this person is trolling, but is a little on the uninformed side.

This is not a bad, or unusual question. In fact, just two short years ago I sat across from a balding, whining, hand-wringing neurologist who asked me the same query during my med school interview. He seemed genuinely baffled at the reason why a nurse couldn't just call him for every "neuro" case that presented. Judging by the thin envelope I got from that institution a couple of weeks later, I guess my answer wasn't that convincing 🙄.

However, when asked it again (no joke) at my present school's interview, they really dug it. 😀

So here goes.

Hey ya-
As a former nurse, that performed triage, and as a hopeful future EP, from my experience the overlap begins and ends with the definition of "triage" = sorting.

Triage nurses get the first view of patients presenting to the ED. Their role is to quickly assess the patient's condition, make a decision on where they should go and how fast. They use basic tools of physical assessment to aid in this decision. Depending on the facility and practice guidelines, they may initiate some bridging/stabilizing treatments and diagnostics E.G. 02, albuterol, fever reduction, EKG etc. They then place the patients in order of seriousness so that they can receive definitive assessment and care by a DOCTOR.

EPs are also charged with this sort of decision making. The difference is the vast body of knowledge and stabilizing interventional skills with which these physicians are armed. Four years of medical school and three to four years of additional training in residency gives the EP an enormous medical knowledge and skill base from which she can guide a patient's care. They have the tools to stabilize the critically ill/injured and the knowledge base and communication skills to accurately assess and make a plan for a patient and/or consult another specialist or a PCP if needed.

Compare this to the average nurse's training of 2-4 years where most of the education is in care-giving and not "medicine-based".

Medicine in general is composed of acquiring data and then forming a plan for a patient via a cascade of decisions. EM is the profession where these decision trees are exposed and backlit by the interdependence of the ED on other specialties and the parameters of a given facility.

Accurate, fast decision making is the hallmark of good EPs and triage nurses. It is also where the similarities between the two professions end.

 

[fuegorama]

Don't triage nurses take your blood pressure and temperature, and check of the little boxes on the chart off of what you tell them?

They could probably just stick a tech or CNA up there to do that. Triage nurses don't actually do interventions. Most nurses hate getting assigned to triage because they have to play CNA for the few hours they are doing it.

I suppose if you wanted to compare an EP to a triage nurse you could, but then again, when is the last time you saw an EP taking v/s on everyone in the waiting room?

I see by the tag line under your avatar that you want to be an EP.
As a certified emergency nurse (CEN) and fellow paramedic I encourage you to either correct your ignorance about emergency nursing or refrain from insulting the folks that "draw" triage.

Maybe you haven't had a chance to work in larger centers and that's the reason for your comments, but you need to recognize the importance of those folks in the front of the department.

The hated triage box is where the hospital meets the community. Yep, on a slow evening it may just be one set of vital signs after another, but on those crappy nights it turns into a wikkid nightmare.

Seventeen people waiting, two with chest pain, a peds asthmatic sitting in your chair puffing a neb, an old guy with bladder retntion that gets a foley behind the only curtain, and then that 22 year old woman on oral contraceptives with the swollen calf and SOB rolls in. Who gets the only bed in the department? Which of the other CPs will you spend your "favor" chips on by tagging a doc?

Collectively these folks are the responsibility of the department. However, at the end of the day or the beginning of a lawsuit, the physician "owns" that patient. EPs depend on a nurse that has a clue to let them know who really needs them.

There is no more social/interdependent specialty than EM. (at least I haven't seen it 😉 ) Everyone in the department has a role. With rare exceptions, everyone is significant and has an impact on patient outcome.

Learn this early, like now. Hopefully we will both be able to achieve our goal.

 

[Febrifuge]

They could probably just stick a tech or CNA up there to do that. Triage nurses don't actually do interventions. Most nurses hate getting assigned to triage because they have to play CNA for the few hours they are doing it.

Uhh, not exactly. On most shifts, they will put a tech-type person at the desk, with one or two RNs. And some of the RN's would probably rather be running around on the floor, because of personal preference and temperament. But some love triage, because it's the most open-ended, independent and assessment-based thing a lot of ED nurses do. As noted above, the decisionmaking is a pain in the @ss. Many CNA's frankly can't be relied upon to know a pneumothorax from an appy from bad seafood, and certainly not after 20 seconds of assessment.

Yeah, as an EMT I'm better-trained for that type of thing, and I have wondered (sometimes aloud) if maybe I should't be required to do more of it. The answer is, it's hospital policy and the RN's scope of practice - and liability - as defined by that policy makes him/her the decision-maker. This is fine with me, since a lawsuit would scuttle my career before it starts. I've dressed wounds, helped get history, and bumped people to the front of the line to get looked at by the nurse -- but at that desk, the Triage RN is my boss.

And hell yes, they do interventions. I don't know about your ED, but ours has standing orders for more than a couple of drugs. It's a lot more like being a medic than you might think. 😀

 

[Febrifuge]

...on a slow evening it may just be one set of vital signs after another, but on those crappy nights it turns into a wikkid nightmare... Seventeen people waiting, two with chest pain, a peds asthmatic sitting in your chair puffing a neb, an old guy with bladder retention that gets a foley behind the only curtain, and then that 22 year old woman on oral contraceptives with the swollen calf and SOB rolls in. Who gets the only bed in the department?

Rock on! Excellent post. I think more pre-med people need to experience the majesty of this kind of night. It's better than any school, in terms of the way you learn respect.

Okay, so you send the volunteer back to cruise the exam area and see if anybody's been discharged, but hasn't been taken out of the computer yet. You call the Peds center and see if they can boot the guy with the med refill back to the Peds waiting room; he can watch Finding Nemo for a little bit while the neb kid goes back. The tech will make the bed and get kiddo plugged into a pulse-ox monitor. Foley Guy can chill in the curtain. For now. Chest Pain 1 and Chest Pain 2 stay where we can see them, and I swear to god, if Judy comes back from break without my coffee...

 

[Purulent DC]

I tried multiple times to get accepted into nursing school. After 5 attempts all followed by rejections, I was very discouraged. I thought my childhood dreams of becoming a triage nurse were squashed forever. Then I realized that if I could at least get a job working in a field closely related to triage nursing, my life might not be that bad. I mean everyone knows that becoming a triage nurse is nearly impossible these days and reserved for only the best of the best. So I applied to medical school, graduated, and have now secured a residency position in EM. Sure, I will never be a triage nurse, but at least I can interact with them on occasion and support them in my job as an EM physician, which is a job almost as fulfilling and not as bad as most triage nurses would say. There are many days when I catch a glimpse into that special room adjacent to the waiting area and watch wistfully while the head triage nurse pumps up a BP cuff or takes a temperature and I think to myself, "I could do that!" But I know that for whatever reason I wasn't qualified and I have come to accept my role as just an EM doc. Yeah, sure it sometimes feels belittling to have the initials "MD" following my name, instead of "LPN" or "RN." But at the end of the day we are all a part of a team that is making a difference in people's lives, and I am glad to play a role, albeit a small one, in the field of triage nursing.

 

[lawmd]

having been a CNA in the ED and now an EM intern, I have had a unique view of both sides. Triage is tough, and the nurses can sometimes get alot of grief for it. sometimes the pt will not give much history or simply not want to mention that they have had 15 rounds of unprotected anal intercourse to the triage nurse. things can often get much more complicated once the pt is in a gown and more info comes out.

I think it would be a great experience for residents to spend one or two shifts in the "triage box" during residency to get a close look at this very tough job.

now for the OP-why we are not "triage nurses." Having been in the ED for a few months now, there are times where I do feel like a triage nurse. SO MANY patients cannot get into their PCP for simple things and present to the ED with primary care complaints, not true emergencies. With resources being somewhat limited in the ED, there are times that all we can do is rule out the bad stuff and have them follow up with their doctor or over to ortho clinic. While they may not be emergencies, they are emergencies in the eyes of the patient, and need to be addressed, if not to just ease their mind. PA's and NP's can help fulfill this role in many EDs. I do not have anything bad to say about PAs and NPs, I think they are very valuable. The key is that they still check things by a physicians, who has a broader differential running around in the back of their mind, possibly has a better understanding of the pts physiology. Just as an FP or internist can diagnose ACS without being a cardiologist, the PA or NP can do a lot to help in the ED.

Alot of time I feel more like a social/public health worker than a triage nurse or physician. As an ED doc I have to know about community resources, how to get a bus pass, home health nurse follow-up, STD testing, behavioral health issues, school physicals, etc... I also have to be up to date on the new street drugs, that high school wrestlers are having problems with MRSA, that penis and clit piercings are cool, that there is an increase in hispanic gang activity, and how to really effectively screen for domestic violence and rape.

We are not triage nurses because we have been to medical school. We do a 3-4 year residency where we spend 80+ hours a week seeing the gamut of physical disease, putting g-tubes back in at 3am, the neutropenic fever, codes, labor that isn't progressing, etc... When the seemingly easy diagnosis of "dizzy" presents at 2pm sunday afternoon while singing at church, we have to think of 15 other possible diagnoses that could kill this person. I don't want the nurse at triage to be at the helm if this is my mother. I find that there is nothing wrong, recommend weight loss and to stay away from fried chicken, and ask her to follow up with her PCP.

The nurse who has been working for 20 years who has seen 100's of central lines asks me to put the central line in the patient who needs dopamine NOW. I have seen three, and have failed two of them myself. I get the kit, find the pulse with a doppler, and go for it. I have taken gross anatomy, I guess that is why I am more qualified? when the s##t hits the fan, they call the doctor, bottom line. I get the LP tray for the 400 pound woman with a headache and no discernible landmarks. We don't get 30 minutes of protected time every day for lunch breaks. There are 12 hour shifts where I don't eat or even urinate. We can't take 10 minutes every two hours for a smoke break either. I can't leave exactly at 11pm when my shift is "over." Those are a few things that make us different from the triage nurse. I am not complaining, nor putting down nursing-many of the ED nurses I have met are brilliant and know how to work in the crunch. I love my job and the responsibility and rewards that come with it. I knew what I was getting into by seeing it as a CNA before starting medical school.

As for physicians who consider ED docs to be triage nurses, they have deep problems with themselves. Any physician who degrades another specialty is a prick. I have seen a critical care doctor with a pretty bad reputation for bashing EM physicians roll into the ED as a patient suffering with a stroke. he did fine, but the words he spoke with a paralyzed face will stick with me forever-"please doc, help me." With a cup of coffee in his hand and a cool voice the EP simply said, "don't worry, we'll take care of you." And we did. And he is still an ass.

We don;t know everything, never will. But we know more about everything, than any other specialty. "Jack of all trades, master of none" as some people say. Broken fingers, vaginal bleeding, MI, renal failure, optho, radiology, dentistry, etc... The internist who complains about the "soft admit" for chest pain, doesn't see the 15 patients we send back to the chest pain center over night for rule out. Will I know the exact cause of the person's abdominal pain in every case? No. But I have seen internists and surgeons mentally masturbate on rounds for 2 weeks over the same patient. I have even seem the same physicians discharge patients home, and have them return to the ED with the diagnosis still not being made. Also, patients who have been discharged home only to return to the ED to deal with the post-op complications. Most of the time I can take care of it and send them home. If it is complicated and the surgeon needs to see the patient, I call. Does this make me a triage nurse? Maybe so in some eyes. Our rounds are 2 minutes as you and the attending walk into the room. We don't have the luxury of sipping coffee and figuring out which 7th generation quinolone has a greater MAC in stagnant urine in a quadriplegic patient with a creatinine clearance of 3. i also see and do more in a 12 hour ED shift than on a 30 hour gen surg shift.

Even more, i see 5 patients a day who are told to go to the ED for their complaint-even for pharyngitis. If anything, the ED has become a dumping ground for doctors offices that have become overfilled and where patients have to go because there is no alternative because they aren't taking new patients or their office closes at noon on fridays. If physicians want to demean EPs, I say we let them carry the pager to see THEIR patients for everything, 24/7-weekends and holidays. The evolution of EM has taken a lot of the load off of other specialties. We all chose to enter this profession-you have to take to take the good and the bad-even those annoying calls from the "ED triage nurse doctor." The internist gets weekends and nights off with occasional call-some much more than others. I respect them immensely. The EP works nights and weekends and gets 15 days off a month. Give and take, good and bad. We are all supposed to be taking care of the patient. The overwhelming majority do this very well.

Just my 3 cents...

 

[edinOH]

The main difference is the little skirt and white hat the nurses wear in triage. You can tell I'm the doc by the big head-lamp I wear around the department.

By the way...those skirts are HOT!

 

[Hercules]

having been a CNA in the ED and now an EM intern, I have had a unique view of both sides. Triage is tough, and the nurses can sometimes get alot of grief for it. sometimes the pt will not give much history or simply not want to mention that they have had 15 rounds of unprotected anal intercourse to the triage nurse. things can often get much more complicated once the pt is in a gown and more info comes out.

I think it would be a great experience for residents to spend one or two shifts in the "triage box" during residency to get a close look at this very tough job.

now for the OP-why we are not "triage nurses." Having been in the ED for a few months now, there are times where I do feel like a triage nurse. SO MANY patients cannot get into their PCP for simple things and present to the ED with primary care complaints, not true emergencies. With resources being somewhat limited in the ED, there are times that all we can do is rule out the bad stuff and have them follow up with their doctor or over to ortho clinic. While they may not be emergencies, they are emergencies in the eyes of the patient, and need to be addressed, if not to just ease their mind. PA's and NP's can help fulfill this role in many EDs. I do not have anything bad to say about PAs and NPs, I think they are very valuable. The key is that they still check things by a physicians, who has a broader differential running around in the back of their mind, possibly has a better understanding of the pts physiology. Just as an FP or internist can diagnose ACS without being a cardiologist, the PA or NP can do a lot to help in the ED.

Alot of time I feel more like a social/public health worker than a triage nurse or physician. As an ED doc I have to know about community resources, how to get a bus pass, home health nurse follow-up, STD testing, behavioral health issues, school physicals, etc... I also have to be up to date on the new street drugs, that high school wrestlers are having problems with MRSA, that penis and clit piercings are cool, that there is an increase in hispanic gang activity, and how to really effectively screen for domestic violence and rape.

We are not triage nurses because we have been to medical school. We do a 3-4 year residency where we spend 80+ hours a week seeing the gamut of physical disease, putting g-tubes back in at 3am, the neutropenic fever, codes, labor that isn't progressing, etc... When the seemingly easy diagnosis of "dizzy" presents at 2pm sunday afternoon while singing at church, we have to think of 15 other possible diagnoses that could kill this person. I don't want the nurse at triage to be at the helm if this is my mother. I find that there is nothing wrong, recommend weight loss and to stay away from fried chicken, and ask her to follow up with her PCP.

The nurse who has been working for 20 years who has seen 100's of central lines asks me to put the central line in the patient who needs dopamine NOW. I have seen three, and have failed two of them myself. I get the kit, find the pulse with a doppler, and go for it. I have taken gross anatomy, I guess that is why I am more qualified? when the s##t hits the fan, they call the doctor, bottom line. I get the LP tray for the 400 pound woman with a headache and no discernible landmarks. We don't get 30 minutes of protected time every day for lunch breaks. There are 12 hour shifts where I don't eat or even urinate. We can't take 10 minutes every two hours for a smoke break either. I can't leave exactly at 11pm when my shift is "over." Those are a few things that make us different from the triage nurse. I am not complaining, nor putting down nursing-many of the ED nurses I have met are brilliant and know how to work in the crunch. I love my job and the responsibility and rewards that come with it. I knew what I was getting into by seeing it as a CNA before starting medical school.

As for physicians who consider ED docs to be triage nurses, they have deep problems with themselves. Any physician who degrades another specialty is a prick. I have seen a critical care doctor with a pretty bad reputation for bashing EM physicians roll into the ED as a patient suffering with a stroke. he did fine, but the words he spoke with a paralyzed face will stick with me forever-"please doc, help me." With a cup of coffee in his hand and a cool voice the EP simply said, "don't worry, we'll take care of you." And we did. And he is still an ass.

We don;t know everything, never will. But we know more about everything, than any other specialty. "Jack of all trades, master of none" as some people say. Broken fingers, vaginal bleeding, MI, renal failure, optho, radiology, dentistry, etc... The internist who complains about the "soft admit" for chest pain, doesn't see the 15 patients we send back to the chest pain center over night for rule out. Will I know the exact cause of the person's abdominal pain in every case? No. But I have seen internists and surgeons mentally masturbate on rounds for 2 weeks over the same patient. I have even seem the same physicians discharge patients home, and have them return to the ED with the diagnosis still not being made. Also, patients who have been discharged home only to return to the ED to deal with the post-op complications. Most of the time I can take care of it and send them home. If it is complicated and the surgeon needs to see the patient, I call. Does this make me a triage nurse? Maybe so in some eyes. Our rounds are 2 minutes as you and the attending walk into the room. We don't have the luxury of sipping coffee and figuring out which 7th generation quinolone has a greater MAC in stagnant urine in a quadriplegic patient with a creatinine clearance of 3. i also see and do more in a 12 hour ED shift than on a 30 hour gen surg shift.

Even more, i see 5 patients a day who are told to go to the ED for their complaint-even for pharyngitis. If anything, the ED has become a dumping ground for doctors offices that have become overfilled and where patients have to go because there is no alternative because they aren't taking new patients or their office closes at noon on fridays. If physicians want to demean EPs, I say we let them carry the pager to see THEIR patients for everything, 24/7-weekends and holidays. The evolution of EM has taken a lot of the load off of other specialties. We all chose to enter this profession-you have to take to take the good and the bad-even those annoying calls from the "ED triage nurse doctor." The internist gets weekends and nights off with occasional call-some much more than others. I respect them immensely. The EP works nights and weekends and gets 15 days off a month. Give and take, good and bad. We are all supposed to be taking care of the patient. The overwhelming majority do this very well.

Just my 3 cents...

Nice post! 👍 👍

 

[USCDiver]

Did the OP really mean to put Trauma in the Title and triage in the body of his post?

This is not a bad, or unusual question. In fact, just two short years ago I sat across from a balding, whining, hand-wringing neurologist who asked me the same query during my med school interview. He seemed genuinely baffled at the reason why a nurse couldn't just call him for every "neuro" case that presented. Judging by the thin envelope I got from that institution a couple of weeks later, I guess my answer wasn't that convincing .

So what this guy envisioned was an ED where there was one of each subspecialty to see each patient that came in? One neurologist, one surgeon, one IM, one FP, one Ob/Gyn, etc... because if he thinks he ever going to leave a busy ED if he's getting called down for every neuro case he's kidding himself.

 

[DOrk]

Collectively these folks are the responsibility of the department. However, at the end of the day or the beginning of a lawsuit, the physician "owns" that patient. EPs depend on a nurse that has a clue to let them know who really needs them.


Having spent the past three months in various ED's, I've seen the outcome of good (and bad) triage. A good triage nurse is the EP's best friend; a bad triage nurse is an EP's worst enemy.

 

[DOrk]

Any physician who degrades another specialty is a prick.


Perhaps the wisest words written in this thread so far. I spoke to an internist last week who told me that "real doctors don't work in the ER." Then why do you always dump your patients on the ER, Doc? I guess he had a rough night on call or something.

 

[roja]

I?ve heard people on this board and elsewhere refer to EP?s as glorified triage nurses. Why do people make that comparison? How do EP?s distinguish themselves from that particular nursing specialty?

LT

roja, md.

 

[LTbulldogs]

Thanks for your thoughtful responses, although I do believe some of you completely misinterpreted my original question. I simply wanted to know where the fields overlap. I am fully aware of the educational requirements of an Emergency Physician and I?ve never compared a physicians? education to that of a nurses?, as some of you have suggested. The demeaning rhetoric in previous posts speaks volumes to the sensitivity and reality of the situation. Rather than someone simply debunking my misinformation, I was assaulted on every level...That reaction alone, especially considering the amount of derogatory posts, reveals the veracity of the state of affairs. I liken your reaction to a third grader approaching an English professor to ask for a coloring book. Rather than the professor saying, ?hey kid, I?m not in the coloring book business, I?m a college professor.? He says, ?Listen you stupid kid, I?m better than those coloring book hander-outers, I?m a goddamn professor of American Literature? Now, why would an English professor say that? Well, he could just be a prick, that?s possible. But if the kid receives similar responses from different professors, there?s likely to be internal problems with the profession as a whole?And Considering the amount of negative responders to my post, I would assume something to be critically wrong with the state of emergency medicine. Am I wrong?

LT

 

[LTbulldogs]

having been a CNA in the ED and now an EM intern, I have had a unique view of both sides. Triage is tough, and the nurses can sometimes get alot of grief for it. sometimes the pt will not give much history or simply not want to mention that they have had 15 rounds of unprotected anal intercourse to the triage nurse. things can often get much more complicated once the pt is in a gown and more info comes out.

I think it would be a great experience for residents to spend one or two shifts in the "triage box" during residency to get a close look at this very tough job.

now for the OP-why we are not "triage nurses." Having been in the ED for a few months now, there are times where I do feel like a triage nurse. SO MANY patients cannot get into their PCP for simple things and present to the ED with primary care complaints, not true emergencies. With resources being somewhat limited in the ED, there are times that all we can do is rule out the bad stuff and have them follow up with their doctor or over to ortho clinic. While they may not be emergencies, they are emergencies in the eyes of the patient, and need to be addressed, if not to just ease their mind. PA's and NP's can help fulfill this role in many EDs. I do not have anything bad to say about PAs and NPs, I think they are very valuable. The key is that they still check things by a physicians, who has a broader differential running around in the back of their mind, possibly has a better understanding of the pts physiology. Just as an FP or internist can diagnose ACS without being a cardiologist, the PA or NP can do a lot to help in the ED.

Alot of time I feel more like a social/public health worker than a triage nurse or physician. As an ED doc I have to know about community resources, how to get a bus pass, home health nurse follow-up, STD testing, behavioral health issues, school physicals, etc... I also have to be up to date on the new street drugs, that high school wrestlers are having problems with MRSA, that penis and clit piercings are cool, that there is an increase in hispanic gang activity, and how to really effectively screen for domestic violence and rape.

We are not triage nurses because we have been to medical school. We do a 3-4 year residency where we spend 80+ hours a week seeing the gamut of physical disease, putting g-tubes back in at 3am, the neutropenic fever, codes, labor that isn't progressing, etc... When the seemingly easy diagnosis of "dizzy" presents at 2pm sunday afternoon while singing at church, we have to think of 15 other possible diagnoses that could kill this person. I don't want the nurse at triage to be at the helm if this is my mother. I find that there is nothing wrong, recommend weight loss and to stay away from fried chicken, and ask her to follow up with her PCP.

The nurse who has been working for 20 years who has seen 100's of central lines asks me to put the central line in the patient who needs dopamine NOW. I have seen three, and have failed two of them myself. I get the kit, find the pulse with a doppler, and go for it. I have taken gross anatomy, I guess that is why I am more qualified? when the s##t hits the fan, they call the doctor, bottom line. I get the LP tray for the 400 pound woman with a headache and no discernible landmarks. We don't get 30 minutes of protected time every day for lunch breaks. There are 12 hour shifts where I don't eat or even urinate. We can't take 10 minutes every two hours for a smoke break either. I can't leave exactly at 11pm when my shift is "over." Those are a few things that make us different from the triage nurse. I am not complaining, nor putting down nursing-many of the ED nurses I have met are brilliant and know how to work in the crunch. I love my job and the responsibility and rewards that come with it. I knew what I was getting into by seeing it as a CNA before starting medical school.

As for physicians who consider ED docs to be triage nurses, they have deep problems with themselves. Any physician who degrades another specialty is a prick. I have seen a critical care doctor with a pretty bad reputation for bashing EM physicians roll into the ED as a patient suffering with a stroke. he did fine, but the words he spoke with a paralyzed face will stick with me forever-"please doc, help me." With a cup of coffee in his hand and a cool voice the EP simply said, "don't worry, we'll take care of you." And we did. And he is still an ass.

We don;t know everything, never will. But we know more about everything, than any other specialty. "Jack of all trades, master of none" as some people say. Broken fingers, vaginal bleeding, MI, renal failure, optho, radiology, dentistry, etc... The internist who complains about the "soft admit" for chest pain, doesn't see the 15 patients we send back to the chest pain center over night for rule out. Will I know the exact cause of the person's abdominal pain in every case? No. But I have seen internists and surgeons mentally masturbate on rounds for 2 weeks over the same patient. I have even seem the same physicians discharge patients home, and have them return to the ED with the diagnosis still not being made. Also, patients who have been discharged home only to return to the ED to deal with the post-op complications. Most of the time I can take care of it and send them home. If it is complicated and the surgeon needs to see the patient, I call. Does this make me a triage nurse? Maybe so in some eyes. Our rounds are 2 minutes as you and the attending walk into the room. We don't have the luxury of sipping coffee and figuring out which 7th generation quinolone has a greater MAC in stagnant urine in a quadriplegic patient with a creatinine clearance of 3. i also see and do more in a 12 hour ED shift than on a 30 hour gen surg shift.

Even more, i see 5 patients a day who are told to go to the ED for their complaint-even for pharyngitis. If anything, the ED has become a dumping ground for doctors offices that have become overfilled and where patients have to go because there is no alternative because they aren't taking new patients or their office closes at noon on fridays. If physicians want to demean EPs, I say we let them carry the pager to see THEIR patients for everything, 24/7-weekends and holidays. The evolution of EM has taken a lot of the load off of other specialties. We all chose to enter this profession-you have to take to take the good and the bad-even those annoying calls from the "ED triage nurse doctor." The internist gets weekends and nights off with occasional call-some much more than others. I respect them immensely. The EP works nights and weekends and gets 15 days off a month. Give and take, good and bad. We are all supposed to be taking care of the patient. The overwhelming majority do this very well.

Just my 3 cents...

Great post, thanks a lot...that's exactly what I was hoping for!

 

[roja]

Thanks for your thoughtful responses, although I do believe some of you completely misinterpreted my original question. I simply wanted to know where the fields overlap. I am fully aware of the educational requirements of an Emergency Physician and I?ve never compared a physicians? education to that of a nurses?, as some of you have suggested. The demeaning rhetoric in previous posts speaks volumes to the sensitivity and reality of the situation. Rather than someone simply debunking my misinformation, I was assaulted on every level...That reaction alone, especially considering the amount of derogatory posts, reveals the veracity of the state of affairs. I liken your reaction to a third grader approaching an English professor to ask for a coloring book. Rather than the professor saying, ?hey kid, I?m not in the coloring book business, I?m a college professor.? He says, ?Listen you stupid kid, I?m better than those coloring book hander-outers, I?m a goddamn professor of American Literature? Now, why would an English professor say that? Well, he could just be a prick, that?s possible. But if the kid receives similar responses from different professors, there?s likely to be internal problems with the profession as a whole?And Considering the amount of negative responders to my post, I would assume something to be critically wrong with the state of emergency medicine. Am I wrong?

LT

Granted, I skimmed the responses, however, I dont' recall seeing anyone calling you stupid. Asking professional physicians how thier job differs from a triage or trauma nurse is very niave. There are MANY trolls who have dropped in here to insult the specialty. And as you singled out EM (you didn't ask how a fp nurse differs from a fp MD or a surgical tech differs from a surgeon) implies that you think there aren't a lot of difference between the two.

Nurses are an invaluable part of the team in the ED. However, if they could run the ED, then there wouldn't be a need for EP's.

The diffence is so vast between an EP and a nurse, I wouldn't even know where to begin.

What exactly are you looking for? Descriptions of what we do? Why we like it? Whats our day like? Asking how EP's differ from nurses skirts the offensive.


We also tend to have a sense of humor.

 

[WilcoWorld]

We also tend to have a sense of humor.

This is one of the main reasons I became interested in EM. Unfortunately, the responses I've seen on this thread have me 2nd guessing myself. Are the egos of EP's really so fragile that a poorly worded question from someone who admits ignorance can provoke such nastieness? I sure hope not.

Perhaps "trolls" of threads past have lowered the anger threshold on this forum, or perhaps it's the fact that I'm an MS4 who has only endured 6 months of EM-directed ridicule and thus can still let it roll off my back.

 

[Febrifuge]

We're trying that brooding, sultry, moody thing for a while. Gotta keep people guessing, you know?

 

[roja]

This is one of the main reasons I became interested in EM. Unfortunately, the responses I've seen on this thread have me 2nd guessing myself. Are the egos of EP's really so fragile that a poorly worded question from someone who admits ignorance can provoke such nastieness? I sure hope not.

Perhaps "trolls" of threads past have lowered the anger threshold on this forum, or perhaps it's the fact that I'm an MS4 who has only endured 6 months of EM-directed ridicule and thus can still let it roll off my back.

I think what you will find is that the egos aren't fragile in the least. What is tiring is people who get all pissy when people take joking as some kind of personal affront. Then it gets a little hotter in here.

I love specialty jokes... it just gets tiring when people post with high and mighty attitudes in here when people are joking. But then, context can be tricky in text. 🙂

 

[lawmd]

LT-where are you in your medical training? Just out of curiosity-that might help us understand where you are coming from. if you are a 10th grader doing a school project, it is understandable. If you are a 2nd or 3rd year medical student, get out from under the library desk and take a look for yourself.

there is nothing critically wrong with EM. There are a few things with medicine as a whole, and as EM being the safety net for medicine and society-there are some inherent problems within the specialty, many of which I mentioned above. When patients have to come to the ED for a med refill ($350 ED visit) because they can't get into their PCP office for 3 months, then that is a problem within the field of primary care, but it becomes my problem. There needs to be more medical schools and incentives for people to enter primary care, instead of sub-sub specializing into particular joints, and mucous membranes. There also needs to be more people accepted into medical schools who have experienced medicine(and life) and not just done well on the MCAT. Although that is another matter, I won't rant here...

The thing that is critically wrong is that many people in the medical field, or those who have no experience in EM other than the TV shows, view EM as "triage". That is why you should spend a few shifts in the trenches and become informed for yourself and not propagate these myths. It is interesting to see the IM resident get pissed off at his or her own service while doing their EM rotation. Walk a mile in the other person's shoes....

Not only do we have to treat patients, we have to wait for nursing administration to open beds, for consultants to come to the ED before the pt goes to the floor, for the CT scanner to be available. So not only are we seeing patients, we are in control of FLOW of the department-this is an art form which takes years to develop and longer to master. If I had time to fully diagnose the pt's condition, I would, but my job is to make sure we don;t have 15 patients in the hallway on stretchers, that the medics aren't waiting on nurses to check the patients in, and be on the phone with EMS dispatch to manage the 15 car pileup which might be sending me 12 patients. So, by looking a bit deeper into the situation, one might see that there are quite a few other responsibilities that come along with the role of Emergency Physician, not just diagnosing disease.
So we may not know the intricacies of the most recent HIV therapy or TPN formulations, we are very knowledgeable in multi-tasking!! I think that is part of the attraction of EM and is why many people choose this field.


Just another 3 cents...

 

[doctor7]

I?ve heard people on this board and elsewhere refer to EP?s as glorified triage nurses. Why do people make that comparison?

LT

Because being on call sucks and it just pisses you off when the ER guy gets to go home at the end of his shift. In fact, the intensity of animosity aimed at ER docs is pretty much proportional to how little you're getting laid and how long it's been since you've had a day off. General Surgery residents absolutely hate the EPs while Radioholiday guys couldn't give a damn.

How do EP?s distinguish themselves from that particular nursing specialty?

LT

at least an extra $100K per year.


...if I had to bet one way or another, I'd go with Troll.

 

[roja]

Our surgeons rock. We love them. We try to get htem drunk on the rare times they go out. 😀

 

[hello23]

I sure hope someone is learning something from this useful thread for their interview

 

[FoughtFyr]

...if I had to bet one way or another, I'd go with Troll.

Look at his posting history. Definite troll.

- H

 

[Sessamoid]

Look at his posting history. Definite troll.

- H

Yeah, I checked the posting history as well. No argument with you there.

BTW, how do you like the new avatar? My brother made it.

 

[lawmd]

sessamoid-maybe in light of the recent fight, you could add a pair of handcuffs and jumpsuit

 

[lawmd]

LTBulldog-looking at your posts, you suck. I can't believe I wasted 15 minutes of my life typing a reply to someone like yourself. You went to Harvard, please tell me that is a joke. We will see you in 30 years, holed up in a cabin sending mail bombs, raping small children. Go play in traffic.

 

[LTbulldogs]

LTBulldog-looking at your posts, you suck. I can't believe I wasted 15 minutes of my life typing a reply to someone like yourself. You went to Harvard, please tell me that is a joke. We will see you in 30 years, holed up in a cabin sending mail bombs, raping small children. Go play in traffic.

Ok, I don?t think that was necessary nor do I believe my posts are trollish?Hell, I have 250 of them. Granted, I tend to go off the deep end sometimes, but not very often. I rarely post and when I do, it's usually in the everyone forum. I mainly (as most people do) just read the forums for information. I asked a simple question, you gave a superb answer, and I'm extremely grateful. I?m sorry you feel the way you do Lawmd. I personally don?t believe that you?ve wasted your time, your post was very informative for me and, I?m sure, for others interested in emergency medicine. Here?s a little tip from the student to the doc: You shouldn?t allow others, especially strangers whom you?ve never met, the privilege of altering your mental state?It?s your only true possession?The ability to respond to a situation, good or bad, in a manner controlled only by you. When you relinquish that power, you renounce your freedom? And if you?re not free, you?re more than likely not happy.

LT

 

[Sessamoid]

Ok, I don?t think that was necessary nor do I believe my posts are trollish?Hell, I have 250 of them.

You start a thread titled "EP=Glorified Trauma Nurse?" and you claim that it wasn't a troll? Come now. So if I go to the Surgery forums and start a thread titled "Are Surgeons just overrated butchers?" that you'd consider that an earnest request for reasoned responses?

 

[LTbulldogs]

You start a thread titled "EP=Glorified Trauma Nurse?" and you claim that it wasn't a troll? Come now. So if I go to the Surgery forums and start a thread titled "Are Surgeons just overrated butchers?" that you'd consider that an earnest request for reasoned responses?

By your reasoning, I?ve compared anesthesiologists to professional circus farters; They both pass gas for a living so of course, their association is indisputable?Right? I?m not quite certain I agree with your logic. I simply asked where the fields overlap. To suggest that there isn?t a drastic overlap between physicians and nurses in emergency medicine is to exhibit a profound ignorance of the specialty. The implication that surgeons and butchers share common similarities is irrational and wholly inconsistent with my initial inquiry. But, it was funny!

 

[Sessamoid]

By your reasoning, I?ve compared anesthesiologists to professional circus farters; They both pass gas for a living so of course, their association is indisputable?Right? I?m not quite certain I agree with your logic. I simply asked where the fields overlap. To suggest that there isn?t a drastic overlap between physicians and nurses in emergency medicine is to exhibit a profound ignorance of the specialty. The implication that surgeons and butchers share common similarities is irrational and wholly inconsistent with my initial inquiry. But, it was funny!

You've done basically the same thing. You claim that we all here show a profound ignorance about the specialty, which is laughable since some here have been practicing it for quite a while. If you know so much about the specialty that we practice, then that belies your claim you were simply here seeking wisdom. We're all idiots here, so why ask us? You go on to show your own ignorance by claiming that the comparison between butchers and surgeons is irrational. You do realize that surgery didn't grow from the profession of physcians, don't you? Do you have any idea from which group the practice of surgery started? Not butchers exactly, but barbers.

Your continued refusal to apologize for a blatant insult and continued uninformed arguments are sad, but at least consistent with your previous posting history. Plonk!

 

[Sessamoid]

sessamoid-maybe in light of the recent fight, you could add a pair of handcuffs and jumpsuit

I wonder if Jerry West would find it funny? 😛

 

[roja]

I sure hope someone is learning something from this useful thread for their interview

Certainly those of us that interview residency applicants are. 😎

 

[WilcoWorld]

You shouldn?t allow others, especially strangers whom you?ve never met, the privilege of altering your mental state?When you relinquish that power, you renounce your freedom.
LT

Didn't any of us learn anything about bullies from being nerds in grade school? The "troll" is right about this one.

Though the post that cites EP/nurse overlap, but fails to recognize the origins of Chirurgia (Surgery) does make the OP look rather ignorant, or at least one-sided.

P.S.: Sessamoid - I love the new icon.

 

[FoughtFyr]

Yeah, I checked the posting history as well. No argument with you there.

BTW, how do you like the new avatar? My brother made it.

Love it! Hey anyone from the forum recieve any of the "victims" of that debacle?

- H