Remaining Objective on Difficult Triage Calls

By Ravi Raheja, MD

As a healthcare professional, providing quality care to patients is the number one priority. Most patients are friendly and thankful for the advice and care given, but occasionally a caller can be angry, frustrated, or rude. Though difficult at times, it is important for triage nurses to resist the urge to react negatively.

Nurses must be sure to remain objective by realizing the caller’s anger or frustration is most likely not directed toward them but the situation in general. So, how can a triage nurse overcome labeling a patient as difficult when emotions are running high?

As a triage nurse it is important to attempt to understand the cause of the patient’s behavior. Many times the patient is upset or overwhelmed by pain, worry, or stress. He or she may not know how to effectively communicate symptoms or feelings and become frustrated.

When a nurse fails to empathize and labels a patient as “difficult,” the quality of care can be negatively impacted. Instead of being happy to help, the nurse may talk over the patient in an attempt to be heard or lose interest in the patient’s needs. Neither scenario will accomplish the goal of triage nursing, which is to help the patient attain the safest level of care.

Here are seven tips to help refrain from letting judgments hinder quality patient care:

  1. Breathe:Slow down, take a deep breath, and give the patient time to express themselves.
  2. Empathize:Everyone wants his or her feelings acknowledged. Saying things like “I can understand how you feel that way,” and “I see this is frustrating to you. I am here to help,” can comfort the patient and assure that he or she is being understood.
  3. Address the reason for the patient’s behavior: Once the nurse acknowledges the patient’s feelings and the emotions settle a bit, it’s easier to get to the real reason for the call.
  4. Ask questions:Engage the patient by asking questions to find out exactly what the problem is and what solutions might be possible.
  5. Document facts using objective statements:Refrain from recording judgmental words such as “rude” or “argumentative.” Instead, note actual behaviors such as “patient spoke in a loud, fast voice, and frequently interrupted the nurse.”
  6. Focus on patient care:Rushing the patient off the phone can compromise care. Although difficult calls are uncomfortable, take time to help the patient.
  7. Involve the patient in developing the care plan:Make sure the patient is able and willing to comply. Perhaps a patient is too upset to drive safely to the hospital or is a mother with no one to help with her small children at the ED. Offer alternatives to ensure the safest recommendations for the patient.

Triage nurses hold great responsibility when it comes to patient care. When a nurse follows these steps while handling a difficult call, the patient will get the best possible response. Though challenging at times, the triage encounter should always lead a patient to the best possible outcome and leave a nurse feeling confident they provided the standard of care.

Ravi Raheja is the medical director of TriageLogic. Founded in 2005, TriageLogic is a URAC accredited, physician-led, provider of telephone nurse triage services, triage education, and software for telephone medicine. The TriageLogic group serves over 7,000 physicians and covers over 18 million lives nationwide.