Can the registered nurse triage a patient or perform a Medical Screening Exam (MSE)?

The competent and appropriately trained registered nurse can perform triage activities within the nurse’s scope of practice or under the direction of an authorized health care practitioner – this may include following standing orders.  The registered nurse should use the Scope of Practice Decision Tree to determine if specific activities are within the registered nurse’s legal and individual scope of practice. The Nursing Care Quality Assurance Commission’s Standing Orders and Verbal Orders Advisory Opinion provides additional guidance and recommendations.

The EMTALA is a federal law established in 1986 that requires hospitals or other acute care facilities who offer emergency services to provide a MSE to each person presenting to the emergency department to determine if a medical emergency exists. MSE is beyond initial triage. EMTALA requires the assessment of a patient for the existence of an emergency medical condition before the patient can be transferred or released from the emergency department. The EMTALA Interpretive Guidelines identify the licensed registered nurse to be considered qualified medical personnel who can perform the EMTALA MSE and circumstances where the registered nurse must consult with a physician. MSE requires a comprehensive assessment. The registered nurse should use the Scope of Practice Decision Tree to determine if these activities are within the registered nurse’s legal and individual scope of practice.

All nurses in Washington State are required to complete a suicide prevention training course from an approved list. For more information, see the Washington State Department of Health’s Suicide Prevention Training for Health Professionals Approved Courses.