| The objective of this qualitative, phenomenological study was to reveal the nature of the triage nurses’ experience and the factors associated with assigning acuity levels. Triage is used in almost every hospital-based Emergency Department (ED) in the United States, and most hospitals use the Emergency Severity Index (ESI), a five-tiered algorithm that provides clinically relevant stratification of patients into groups based on resources needed. Inaccurate ESI assessments and long wait times in EDs can lead totriage-related complications that can affect patient morbidity and mortality.This was a qualitative study using semi-structured interviews with triage nurses. Nine triage nurses from different regions across the United States were interviewed about their experiences in triage. Interviews were transcribed verbatim and two reviewers analyzed transcripts following phenomenological principles using Dedoose®. Researchers used a thematic process over several meetings to produce the final set of codes and identify themes. Respondent experiences of triage were described by three themes; the paradoxical process of triage, decision making within chaos and twosides of thelabeling coin.The triage process is complex, dynamic, and highly subjective. Nurses triage patients using traditional assessment methods but use additional approaches to deal with the complex, stressful and rapid ED environment. It is important that ED nurses are aware of the factors which influence their clinical decisions when they are assigning triage levels in the ED to avoid errors during the triage process based on these influences. Keywords: Triage, Decision-making, Nurses, Emergency Department |