Fast Facts for the Triage Nurse, Second Edition: An Orientation and Care Guide

by Lynn Sayre Visser MSN, RN, PHN, CEN, CPEN, FAEN, Anna Sivo Montejano DNP, RN, PHN, CEN

Overview

Emergency Nurses Association Media Award

Media Award: Fast Facts for the Triage Nurse: An Orientation and Care Guide, 2nd Edition – Lynn Sayre Visser, MSN, RN, PHN, CEN, CPEN and Anna Montejano, DNP, RN, PHN, CEN, of California

https://www.ena.org/press-room/2019/06/13/former-ena-president-receives-emergency-nurses-association-s-most-prestigious-award

1st Edition Winner of the AJN Book of the Year Award for Emergency/Critical Care Nursing

This authoritative orientation guide for new and seasoned nurses, preceptors, educators, management teams, urgent care staff, pre-hospital personnel, and anyone working in the triage arena presents essential information to access quickly and repeatedly. Patients rarely present to triage with a diagnosis, but rather convey a multitude of complaints, signs, and symptoms. It is the job of the triage nurse to identify serious “red flag” presentations hidden among all this information while delivering individualized care and juggling wait times in often overcrowded emergency departments.

Fast Facts for the Triage Nurse, Second Edition, retains its key focus on numerous aspects of triage for emergency department and urgent care settings, from orientation, to front-end processes, to clinical practice and nursing essentials. With real-life examples, the chapters detail a multitude of clinical presentations and include procedures and protocols that the triage nurse implements in daily practice. This newly revised and updated edition covers how to build confidence in the triage role, accurately assess patient presentations, reduce personnel and hospital liability, increase patient and staff satisfaction, and, ultimately, deliver quality patient care that supports best outcomes.

5 New Chapters in the Second Edition:

• Active Shooter/Active Violence
• Emergency Management for When Disaster Strikes
• Triage Competency
• Pain Management
• Endocrine Emergencies

Key Features:

• Covers essential clinical information in an easy-to-read format
• Focuses on processes, patient and staff safety, legalities, documentation, and critical thinking at triage
• Addresses specific patient populations including pediatric, older adult, human trafficking, military personnel, and more
• Offers guidance from seasoned emergency department nurses and triage educators

Product Details

ISBN-13:	9780826148513
Publisher:	Springer Publishing Company
Publication date:	12/17/2018
Series:	Fast Facts
Sold by:	Barnes & Noble
Format:	eBook
Pages:	255
File size:	2 MB

About the Author

Lynn Sayre Visser, MSN, RN, PHN, CEN, CPEN, FAEN has devoted her 28 year career to emergency nursing, triage education, mentoring others, and writing about topics that impact nursing. Her career has been complemented by experience in prehospital care, ICUs, post-anesthesia care units, and as an organ procurement coordinator. Her passion for quality patient care led her to play instrumental roles in the implementation of a provider in triage, rapid triage assessment, and immediate bedding processes along with formalized triage education in multiple facilities. She is a change-agent and philanthropist and has been published in a variety of arenas. She is the co-author of Fast Facts for the Triage Nurse: An Orientation and Care Guide, Essentials for the Triage Nurse, Rapid Access Guide for Triage and Emergency Nurses, and Rapid Access Guide for Pediatric Emergency Nursing. Her work has been recognized with two American Journal of Nursing Book of the Year awards, the 2019 Emergency Nurses Association (ENA) Media Award, the 2021 ENA Team Award, as well as the 2019 Sigma Theta Tau Edith Moore Copeland Founders Award for excellence in creativity. She holds a Master of Science Degree in Nursing with an emphasis in education and a double Bachelor of Science degree in nursing and exercise physiology.

Anna Sivo Montejano, DNP, RN, PHN, CEN, has over three decades of experience in emergency nursing and triage education. She has taught nursing theory and aided the professional development of nurses as a preceptor, mentor, and clinical instructor. She has been a certified emergency nurse for more than 30 years. Her ED contributions include work as a staff nurse, primary preceptor, and assistant nurse manager, as well as in educational development. Dr. Montejano has worked to improve the quality and efficiency of patient care through projects such as the change process of rapid medical screenings and rapid triage assessments; as a project manager for a major ED expansion; and as an advanced cardiac life support instructor. She authored Fast Facts for the Triage Nurse: An Orientation and Care Guide in a Nutshell, which won third place in the 2015 American Journal of Nursing Book of the Year awards in the critical care/emergency category, the Emergency Nursing Association, Media award in 2019, and the Assessment Technologies Institute (ATI) Nurse Educator of the Year. This book has since become available in the United Kingdom under the title Essentials for the Triage Nurse: An Orientation and Care Guide. She has her Doctor of Nursing Practice degree from California State University, Northern Consortium (Fresno and San Jose State University), her Master's Degree in Nursing with a focus on education, and her Bachelor of Science degree.

Table of Contents

Reviewers

Foreword Rebecca S. McNair, RN, CEN

Preface

~A Heartfelt Thank You~

Acknowledgments

Part I SETTING THE STAGE FOR SUCCESS AT TRIAGE

1. Orienting to Triage

Lynn Sayre Visser

2. Precepting at Triage

Lynn Sayre Visser

3. Tips for Success at Triage

Lynn Sayre Visser and Anna Sivo Montejano

4. Personal Awareness for the Triage Nurse

Anna Sivo Montejano

5. Triage Competency

Shelley Cohen

Part II POINT-OF-ENTRY PROCESSES IN TRIAGE NURSING

6. The Patient Arrival

Anna Sivo Montejano

7. The Patient Experience in Triage Nursing

Lynn Sayre Visser

8. Legal Concerns in Triage Nursing

Deb Jeffries

Part III NURSING ESSENTIALS FOR EFFECTIVE TRIAGE

9. Triage Acuity Scales

Deb Jeffries

10. Triage Documentation

Rebecca S. McNair

11. Time-Sensitive Medical Conditions

Lynn Sayre Visser

Part IV CURRENT TRENDS IMPACTING TRIAGE NURSING

12. Urgent Care Triage

Valerie Aarne Grossman

13. Electronic Medical Record Considerations

Dawn Friedly Gray

14. Provider in Triage

Lynn Sayre Visser

15. Advanced Triage Protocols

Dawn Friedly Gray

Part V “RED FLAG” PATIENT PRESENTATIONS

16. Introduction to “Red Flag” Presentations

Lynn Sayre Visser

17. Respiratory Emergencies

Polly Gerber Zimmermann and Lynn Sayre Visser

18. Cardiac Emergencies

Polly Gerber Zimmermann

19. Neurological Emergencies

Reneé Semonin Holleran

20. Abdominal Emergencies

Polly Gerber Zimmermann and Lynn Sayre Visser

21. Obstetric and Gynecological Emergencies

Lynn Sayre Visser and Polly Gerber Zimmermann

22. Behavioral Health Emergencies

Anna Sivo Montejano

23. Ocular Emergencies

Anna Sivo Montejano and Lynn Sayre Visser

24. Musculoskeletal Emergencies

Reneé Semonin Holleran

25. Endocrine Emergencies

Dawn Friedly Gray

26. Environmental Emergencies

Anna Sivo Montejano

27. Trauma Emergencies

Reneé Semonin Holleran

28. Infectious Presentations

Anna Sivo Montejano and Lynn Sayre Visser

Part VI SPECIAL CONSIDERATIONS IN TRIAGE NURSING

29. Special Populations in Triage

Anna Sivo Montejano

30. Pediatric Triage

Deb Jeffries

31. Older Adult Triage

Anna Sivo Montejano

32. Pain Management at Triage

Reneé Semonin Holleran

33. Patient and Staff Safety

Anna Sivo Montejano

34. Case Studies in Triage Nursing

Anna Sivo Montejano and Lynn Sayre Visser

Part VII DISASTER SITUATIONS IN TRIAGE NURSING

35. Emergency Management: A Triage Nurse’s Guide for When Disaster Strikes

Erik Angle

36. Active Shooter or Active Violence

Erik Angle

Abbreviations

Appendix A: Resources

Appendix B: Triage Competency Validation Form

Appendix C: Sample Triage Education and Competency Plan

Appendix D: Sample Triage Retrospective Chart Review Audit Form

Appendix E: Disaster Triage Tag

Additional Reading

Index

Editorial Reviews

One of the things that draws nurses into the specialty of emergency nursing is that we love environments where things happen quickly and we are often drawn to brevity. I cannot think of a better format for emergency nurses to learn about the challenges of triage then a book that presents the facts in such a concise and consolidated fashion. It serves as an excellent resource for all emergency nurses, written by respected names in the emergency world.

Solheim Enterprises - Jeff Solheim

.…an easy-to-read guide living up to its claim of providing information “in a nutshell.” The editors have drawn subject matter experts from across the Emergency Nursing profession to write on topics spanning emergency triage tips and regulatory elements through complaint-specific chapters. The book is formatted in bullet points to get right to answering questions for the Emergency Triage Nurse without extra fluff. “Red flags” sections in the chapters help readers zero in on patient safety and quality care while building Emergency Triage Nurse confidence. This resource WILL become part of your valued Emergency Nurse library.

“Triage Decisions” section editor for the Journal of Emergency Nursing - Andi Foley

"A thorough, concise, and well written handbook providing important information for anyone working in the triage arena. A quick read that keeps your attention and delivers down to earth, "in the trenches", dialogue with pertinent, friendly advice and examples. Everything that can walk into the triage area is covered in a succinct yet encompassing way. Well done!!"

Pat Clutter

"A dream team of authors, contributors, and reviewers created a one-of-a kind masterpiece on triage nursing. Building upon the invaluable first edition content, the second edition adds more chapters to cover current nursing concerns. Nurses with various experience levels and practicing in any field will certainly benefit from this easy-to-read and easy-to-understand book. A must have for every nurse’s personal library!

The Inspiration Nurse and author of The ULTIMATE Career Guide for Nurses - Donna Wilk Cardillo

Very impressed by the layout, organization, readability and up-to-date information in this handy reference. Any triage nurse will be a step ahead by having this practice guide- it's like having a seasoned ED nurse in your pocket at all times. Excellent, excellent!

Beth Hawkes

"The authors did an excellent job writing an accurate and up to date guide for triage nurses. 'FAST FACTS' found within each chapter is invaluable! As a nurse with 23 years of ER and critical care experience I would like to see a copy of this book on every triage desk!

Laurie Pittman

…an incredible resource for any emergency department nurse. Information is concise and well-organized for quick reference. Topics are very practical and can be applied to your very next shift. If you’re new to emergency nursing, this book is a must-have.

nurse and creator of the FreshRN® website Kati Kleber

"A concise yet comprehensive reference that cuts to the chase, just like a good emergency nurse. With content covering hot topics such as active shooter situations, pain management, and human trafficking, this book has something for triage nurses at all stages of the novice to expert continuum."

Jean A. Proehl

Not just for nurses. EMS, check this book out! I am a 20+ year paramedic and EMS educator, and I found many of the principles of this book to be very relevant to EMS…. a book that works for both hospital and pre-hospital education.

Lori Gallian

"...for your novice nurse to your most tenured nurse in the department. This book truly has something for everyone in the ED, not only the triage the nurse. The chapters are broken down so no matter your expertise level you can understand what is being presented and learn to provide the best care possible for your patients.

Clinical Manager Emergency Department - Mike Hastings

This book is a true gem and takes much of the guesswork out of the RNs triage process. A must read for all RNs working in the often overwhelming and chaotic world of emergency nursing!"

Thomas Rhodes

A gem of a book, straight to the point with a wealth of knowledge in a nutshell. This condensed, compact and comprehensive quick resource zeroes in on all the essentials of triage nursing. Clear and concise, this book is a must for all emergency department nurses.

Laura Gasparis Vonfrolio

Reviewer: Anna L. Jarrett, PhD, ACNP, FNP - BC(University of Arkansas)
Description: This is the second edition of a book on basic and advanced triage concepts. This edition adds five new chapters and continuing education access and includes guidance from expert emergency department nurses. The first edition was published in 2015.
Purpose: The purpose is to provide new and seasoned nurses, preceptors, educators, and management teams with foundational skills used in triage orientation and when practicing as a triage nurse. The objective is certainly worthy, and the book is necessary. This concise handbook meets the objectives.
Audience: According to the authors, the book is written for new and seasoned triage nurses. This book has the necessary information for providers and healthcare students.
Features: The book reviews triage acuity scales, current trends impacting triage nursing, and "red flag" presentations for each of the body systems. Legal aspects, disasters, and special populations add a specialty component for seasoned triage nurses. The best aspect of the book is the concise, clear review of diseases, injuries, and pediatric trauma. I was particularly impressed with table 2.1. depicting the review of generational comparisons. One shortcoming is the chapter on infectious presentations. Ebola was not discussed as a condition requiring isolation; this should be covered more thoroughly. Zika and acute flaccid myelitis (AFM) are additional examples of topics to include in the third edition.
Assessment: This book is excellent but not perfect. It is a leader in the field and compares favorably with other triage handbooks. It is as good but no better than another book by the same authors, Rapid Access Guide for Triage and Emergency Nurses: Chief Complaints with High Risk Presentations (Springer Publishing, 2018). The second edition is justified, and a third edition will be needed as triage nurses face new diagnoses.

Doody's Review Service

…an incredible resource for any emergency department nurse. Information is concise and well-organized for quick reference. Topics are very practical and can be applied to your very next shift. If you’re new to emergency nursing, this book is a must-have.

Author, nurse and creator of the FreshRN® website - Kati Kleber

"....an easy-to-read guide living up to its claim of providing information "in a nutshell." The editors have drawn subject matter experts from across the Emergency Nursing profession to write on topics spanning emergency triage tips and regulatory elements through complaint-specific chapters. The book is formatted in bullet points to get right to answering questions for the Emergency Triage Nurse without extra fluff. "Red flags" sections in the chapters help readers zero in on patient safety and quality care while building Emergency Triage Nurse confidence. This resource WILL become part of your valued Emergency Nurse library."--Andi Foley, DNP, RN, ACCNS-AG, CEN ""Triage Decisions" section editor for the Journal of Emergency Nursing"

"...an incredible resource for any emergency department nurse. Information is concise and well-organized for quick reference. Topics are very practical and can be applied to your very next shift. If you're new to emergency nursing, this book is a must-have."--Kati Kleber, MSN, RN, CCRN-K "Author, nurse and creator of the FreshRN(R) website"

"...for your novice nurse to your most tenured nurse in the department. This book truly has something for everyone in the ED, not only the triage the nurse. The chapters are broken down so no matter your expertise level you can understand what is being presented and learn to provide the best care possible for your patients."--Mike Hastings, MSN, RN, CEN "Clinical Manager Emergency Department"

"A concise yet comprehensive reference that cuts to the chase, just like a good emergency nurse. With content covering hot topics such as active shooter situations, pain management, and human trafficking, this book has something for triage nurses at all stages of the novice to expert continuum."--Jean A. Proehl, RN, MN, CEN, CPEN, TCRN, FAEN, FAAN

"A dream team of authors, contributors, and reviewers created a one-of-a kind masterpiece on triage nursing. Building upon the invaluable first edition content, the second edition adds more chapters to cover current nursing concerns. Nurses with various experience levels and practicing in any field will certainly benefit from this easy-to-read and easy-to-understand book. A must have for every nurse's personal library!"--Donna Wilk Cardillo, RN, CSP, FAAN "The Inspiration Nurse and author of The ULTIMATE Career Guide for Nurses"

"A gem of a book, straight to the point with a wealth of knowledge in a nutshell. This condensed, compact and comprehensive quick resource zeroes in on all the essentials of triage nursing. Clear and concise, this book is a must for all emergency department nurses."--Laura Gasparis Vonfrolio, RN, PhD

"A thorough, concise, and well written handbook providing important information for anyone working in the triage arena. A quick read that keeps your attention and delivers down to earth, "in the trenches", dialogue with pertinent, friendly advice and examples. Everything that can walk into the triage area is covered in a succinct yet encompassing way. Well done!!"--Pat Clutter, RN, MEd, CEN, FAEN

"Not just for nurses. EMS, check this book out! I am a 20+ year paramedic and EMS educator, and I found many of the principles of this book to be very relevant to EMS.... a book that works for both hospital and pre-hospital education."--Lori Gallian, EMT-P

"One of the things that draws nurses into the specialty of emergency nursing is that we love environments where things happen quickly and we are often drawn to brevity. I cannot think of a better format for emergency nurses to learn about the challenges of triage then a book that presents the facts in such a concise and consolidated fashion. It serves as an excellent resource for all emergency nurses, written by respected names in the emergency world."--Jeff Solheim, MSN, RN, CEN, TCRN, CFRN, FAEN, FAAN "Solheim Enterprises"

"The authors did an excellent job writing an accurate and up to date guide for triage nurses. 'FAST FACTS' found within each chapter is invaluable! As a nurse with 23 years of ER and critical care experience I would like to see a copy of this book on every triage desk! "--Laurie Pittman, BSN, RN, CPEN, Staff Nurse

"This book is a true gem and takes much of the guesswork out of the RNs triage process. A must read for all RNs working in the often overwhelming and chaotic world of emergency nursing!"--Thomas Rhodes, BSN, RN, MPA-HSM, Director of Nursing

"Very impressed by the layout, organization, readability and up-to-date information in this handy reference. Any triage nurse will be a step ahead by having this practice guide- it's like having a seasoned ED nurse in your pocket at all times. Excellent, excellent!"--Beth Hawkes, "Nurse Beth", Career Columnist, Writer, Speaker

From the Publisher