The woman began to grumble and talk at the nurses in an impolite manner. I raised my head, looked at her and shook it speechlessly. A colleague nurse attempted to put forward a defence by responding to her but I signaled him to stop. I don't really fancy helping patients to create a scene.

The woman was upset because she claimed we were skipping the queue to attend to other patients. I was on the nurses' table taking vital signs (blood pressure, pulse, temperature and weight) of patients. Vital signs is routine for patients before seeing the doctor except in few circumstances.

It got to her turn. The woman wasn't the patient but her teenage girl. I took the girl's blood pressure (BP) for three times but I couldn't obtain any value. I told her to wait for a while because her BP was unobtainable.

In about ten minutes time, I re-checked her BP for three times again and it was still not obtainable. I got up and asked a colleague to continue the checking of the vital signs.

There was a history and patient's complain of vomiting and dizziness as I ascertained from the girl's mother. A probable cause of the missing BP value.

I took her folder to the pharmacy myself and requested for 500 ml of Ringers Lactate, one of the drips solutions. Then, moved her unto OPD's improvised resuscitation bed and set up an intravenous line on her. I ran the Ringers Lactate into her in about 15 minutes.

After the infusion, I re-checked the BP again and the value was 84/50 mmHg. This was still lower than the baseline value of 120/80 mmHg. This showed that the patient's circulating blood volume went down and could've gone into instant shock or develop renal complications. This was confirmed by a pulse value of 150 bpm. Even if she had reported with initial BP of 84/50 mmHg, she would've been regarded as emergency patient and handled accordingly.

As part of independent nursing actions, I had planned to add 500 ml of Normal Saline if the BP was still unobtainable. But once the BP became recordable, I took the patient with her mother straight to the consulting room to see a doctor. She was quickly attended to and admitted to the the female ward.

I assisted them to take their medications from the pharmacy and replaced the initial infusion taken.

Before they left for the female ward, I turned to the woman and asked her, "Madam, do you agree with me that you came and met people here but you've seen the doctor before them?" She nodded in the affirmative with flushed face and she began to mumble.

"You've seen the long winding queue we skipped into the consulting room to see the doctor. There are probably others in the queue who will think of you as my relative or acquaintance or something. But that's my work, triage nurse, sorting out critical cases for immediate attention."

"The hospital is not a food vending joint whereby it is first come first serve. If we're going to apply the first come rule, then a lot of people will die unnoticed whiles waiting in queues. When you go to a place for a service, try to be patient particularly if you don't understand their modus operandi. You can also ask questions for clarity. An aggressive reaction is often not a solution to issues - I was upset when you started grumbling at us. But it's atypical of me to reply patients especially in this early morning I haven't even taken koko. Besides, you're by all standards can be my mother and I wouldn't be happy to talk back at my mother."

"You see, not all nurses are the same. We are different. I always state unequivocally that nurses have no right to become angry. I've served in many instances as an arbiter in nurse-patient fracas. But I've in some cases lost it myself. So, next time you visit the hospital, ask questions to understand the protocol. This will help us to serve you because we are because you are."

She left for the ward and I believe some erroneous perceptions she had earlier about nurses being unfair were corrected.

I want to entreat prospective hospital visitors to make it a point to always ask questions for clarity. One huge challenge I've noticed about nurse-patient troubles is ineffective communication. It seems the public sees the nurse as unapproachable - it is true and false. Nurses may be 'custodians' of your health but they are not superhumans. I want to encourage nurses to make themselves more approachable. I personally don't see nursing as a profession that should make one feel pompous and high though it is a privilege to be a nurse.

I've witnessed very harmless nurses language or directive that has upset patients and their relatives. I've come to realize that it is not only the hungry man who is an angry man but the sick man too. Sick persons and their relatives are simply irritable. Therefore, the nurse has to be more patient than the patient.

Education and public awareness will be of great benefit to the nurse and the patient.

The general public should be made to understand that patients are grouped into three categories: Queue, Priority and Emergency Patients. Each of these groups are determined by their vital signs and other discriminators. Besides, whenever I am triaging, a give a very special consideration to pregnant women. In a day that there are more prescribers at post, I extend it not only to female students.

Emergency patients must see the doctor immediately they arrive at the hospital. Priority patients should see the doctor within some determined time lest they will deteriorate into emergency cases. However, Queue patients can wait from morning to evening before seeing the doctor.

So, if you're a Queue patient who has visited the hospital in a day of several emergency cases, you may feel badly treated by none but nurses. As if nurses are the only people in the health delivery system. Admittedly, nurses are the pivot of the system but they don't run the show alone.

Patient and patient's relatives should understand that it is not how they feel that constitutes emergency. Vital signs, discriminator considerations and nurses' assessments are sole determinants of emergency. Thus, if you come to the hospital with bloodied patient, it doesn't mean that a patient without blood stains can't be seen before your patient. 'Blood' is not (always) emergency. The trouble always start when relatives come with their self-triaged emergency patient and are not immediately attended to.

In the case of the girl with the unobtainable BP, she appeared not so bad yet in critical health state.

Again, pain is not emergency but priority. So, a patient may be wailing of pain yet other patients who aren't wailing would be seen first.

Vital signs are the primary indicators of the general health status of a patient. The vital signs are very important to the nurse in taking both dependent and independent nursing decisions. The patient however may not appreciate its relevance that much.

The discriminators basically are signs used to place higher priority on a case over others. For instance, an asthma patient rescued from a smoking building, per discriminator, should be attended to first before other victims of same or similar case.

Most often, I do triaging at the OPD, sorting out emergencies for quick medical attention. I've had so many backlash from patients for cheating them for others. I talk to them sometimes but if I want to spend the time talking to them all the time, I will end up doing nothing. I've garnered a wealth of patients' experiences enough to build a case study. I would find time and write a comprehensive article on some pertinent issues including triaging as a way of educating patients on cooperating with nurses.

But for now, I'm pleading with the public to exercise a high restraint of decorum and patience when they visit the hospital. The nurse is your partner in safeguarding, maintaining and recovering your health.

Health is wealth: the nurse and the patient have a responsibility to building a healthy nation for prosperity.

Thank you.

Abdulai Hanan R. Confidence
Nurse, RGN
Tamale West Hospital
confidencegh@gmail.com
0208455884