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Question:
"I work in a very busy emergency department (120,000 annual visits). We are rewriting our triage guidelines and some staff feel that there should be a limit put on how many hours a nurse can work in triage. Do you have any resources that give guidelines on recommended hours that a triage RN should work in the specific area?"

Answer:
The question of how many hours a nurse should be assigned to triage in any given shift is one that warrants careful consideration given the demands, expectations, responsibilities, and challenges associated with the role. "Working as a triage nurse can be mentally challenging and sometimes exhausting. The triage area frequently is noisy and overcrowded; telephones ring constantly; children cry; and patients, families, and visitors are stressed and demanding" (Emergency Nurses Association, 2005, p. 80).
Even the most experienced nurse is vulnerable to these stressors which can potentially affect our ability to accurately assess and make decisions regarding patients. Long shifts can rob us of our ability to communicate to patients that we do care about them. The ability to project expressive quality (to show that we care) directly affects the patient's perceptions of how much we care about their situation, which in turn affects their perception of the length of time they are waiting. Some facilitates have dealt with this issue by limiting nurses to shorter shifts at triage such as 4-6 hours at a time.
According to Zimmerman & Herr (2006, p. 639), "Triage, if done correctly, is physically and emotionally exhausting. Most limit the triage nurse to 8 hours, but some limit triage to 4-hour shifts. Regardless of the length, it is important to remember to relieve the triage nurse for breaks, just as any other staff nurse".

¹Emergency Nurses Association. (2005). Sheehy's Manual of Emergency Care (6th ed.). Mosby: St. Louis

²Zimmerman, P. G. & Herr, R. (2006). Triage Nursing Secrets. Mosby: St. Louis

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