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Author ORCID Identifier


Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Rachel K. Walker

Second Advisor

Raeann G. LeBlanc

Third Advisor

Jenna L. Marquard

Subject Categories

Emergency Medicine | Other Nursing | Public Health and Community Nursing


Introduction: The emergency triage process is not meeting the needs of the patient or the healthcare team. Current and past research has focused primarily on the emergency triage nurse’s ability to accurately designate the triage acuity score, while largely ignoring the impacts of the complex and dynamic environment in which they are immersed. Therefore, the purpose of this study was to describe the factors that influence the decision-making process of the emergency triage nurse (ETN).

Method: This was a focused ethnographic study that included four phases. Phase 1 was the grand tour of the emergency triage and waiting room area. Phase 2 was the focused observations of the ETN during triage encounters. Instruments used included demographics, pre- and post-measurements of the National Aerospace and Science Administration Task-Load Index (NASA-TLX), and Fatigue Likert score. Phase 3 included the preliminary analysis of field notes to create a framework for the semistructured questions for focus groups to validate findings. Phase 4 involved focus groups of ETNs with field notes and audio transcribed verbatim. The researcher kept field notes on Phases 1, 2, & 4.

Results: Perseverance was a theme for both the ETN and the Team Patient (patient and their accompanying advocate). The model, Perseverance of the Emergency Triage Nurse was developed based on recurring themes involving the personal, interpersonal, organizational, environmental, and temporal factors during the decision-making process. Interruptions remained the biggest distractor. An incidental finding was noted related to the role of Team Patient in the triage process. Although Team Patient was the main contributor of interruptions, they also became an extension of the ETN in monitoring and notifying them of changes.

Discussion: Results of this study illustrated the factors that continue to influence the ETN’s ability to function in their role. It also demonstrated the complexity of the triage process, including interruptions and reprioritizing within a dynamic environment. Although Team Patient was the originator of many of these interruptions, Team Patient remained the patient’s person – their advocate – their voice. Team Patient’s absence during the COVID-19 pandemic has silenced them, thereby creating a gap in care.