Momentary fitting in a fluid environment: A grounded theory of triage nurse decision making

•We explored decision making processes of triage nurses at three hospitals.•A grounded theory of momentary fitting in a fluid environment emerged.•Triage was a collaborative process with two to three nurses working at triage.•At three critical junctures nurses crossed boundaries to create space for patients.•Team situation awareness was maintained by various modes of communication.

BackgroundTriage nurses control access to the Emergency Department (ED) and make decisions about patient acuity, patient priority, and placement of the patient in the ED. Understanding the processes and strategies that triage nurses use to make decisions is therefore vital for patient safety and the operation of the ED. The aim of the current study was to generate a substantive grounded theory (GT) of decision making by emergency triage Registered Nurses (RNs).MethodData collection consisted of seven observations of the triage environment at three tertiary care hospitals where RNs conducted triage and twelve interviews with triage RNs. The data were analyzed by constant comparison in accordance with the classical GT method.ResultsIn the resultant theory, Momentary Fitting in a Fluid Environment, triage is conceptualized as a process consisting of four categories, determining acuity, anticipating needs, managing space, and creating space. The findings indicate that triage RNs continually strive to achieve fit, while simultaneously considering the individual patient and the ED as a whole entity.ConclusionTriage RNs require appropriately designed triage environments and computer technology that enable them to secure real time knowledge of the ED to maintain situation awareness.