Rules for the ER (long)

I know it is cynical, uncaring, and abrasive to say these things.... and I would never actually say them. I really do love my job, I just had a day where everything was wrong... I guess I'm just venting. Feel free to add to the list. Specialties Emergency Article

The Emergency Room

1. The world of ER does not revolve around you. There are sick people here, and you aren't one of them.

2. Our definition of sick is not your definition of sick. If a member of the ER staff says that someone is sick, it means that they are in the process of DYING. They have had a massive stroke, are bleeding out, having a heart attack, or shot. We don't consider a tooth injury sick. Painful, yes. Sick, no.

2. At any given time, one nurse has four patients. One doctor has up to 15. There is a law (similar to Murphy's) in the ER. If you have four patients:

  • One of them will be sick (see #2 for definition)
  • One of them will be whining constantly
  • One of them will be homeless
  • and one of them will be the delightful patient.
  • Don't be the whiner. Please.

3. Physicians and nurses are not waiters. We are not customer service representatives. This is not McDonalds, and you very well may NOT have it your way. Our job is to save your life, or at least make you feel better. If you want a pillow, two blankets, the lights dimmed, and the TV on channel 14, go to the Ramada.

4. If you have one of the three, go to your own doctor in the morning:

  • A cold
  • The flu
  • A stomach virus

5. If your child has a fever, you had better give him tylenol before coming in. Do NOT let the fever remain high just so I will believe the child has a fever. Do you want your child to have a seizure? Do you?

6. We have priorities. We understand that you have been waiting for two hours in the waiting room. If you don't want to wait, make an appointment with a doctor. The little old lady that just walked in looking OK to you is probably having a massive heart attack. That's why she goes first.

7. Do not ask us how long it will be. We don't know. I don't know what's coming through my door 30 seconds from now... so I surely don't know when you'll be getting a room upstairs.

8. We are not for primary care. Get a family doctor, and go see them.

9. If you have diabetes and do not control it, you are committing slow suicide.

10. We know how many times you've been to an ER. We can usually tell if you are faking it on the first 5 seconds of talking to you. Do not lie to us. If you lie about one thing, we will assume you are lying about everything. You don't want that.

11. If you are well enough to complain about the wait, you are well enough to go home.

12. If your mother is a patient and we ask her a question, let her answer it.

13. If you see someone pushing a big cart down the hall at full speed and you hear bells going off.... do not ask for a cup of coffee. Someone is dying, you inconsiderate %#@^. In the ER, bells don't ring for nothing. Sit down, shut up, and let us work.

14. If you have any sort of stomach pain and you ask for something to eat, you are not that sick.

15. If you can complain about the blood pressure cuff being too tight, or the IV needle hurting, you are not in that much pain.

16. If you want to get something, be nice. I will go out of my way to tick off rude people.

17. Do not talk badly about the other members of staff I work with. The doctor that you hate? I work with him every day, and I know that he knows what he is doing. I trust him a lot more than I trust you. I am not here to be your friend, and neither is he. I will tell him what you said, and we will laugh about it. If you want a buddy, go somewhere else.

18. Every time I ask you a question, I learn more about what is wrong with you. I don't care if I ask you what day it is four different times. Each time I ask, it is for a reason. Just answer the questions, regardless of if you have answered them before.

19. Do not utter the words "It's in my chart." I don't have your chart, and I don't have the time to call and get it. Just tell me.

20. Do not bring your entire posse with you. One person at the bedside is all you need. It is really difficult to get around seven people in the event that you are really sick.

If you can ask me if you have time to go smoke a cigarette before the doc comes in to see you....your not sick enough to be here.

Specializes in Emergency & Trauma/Adult ICU.
caroladybelle said:
You know that you can actually BUY A PREGNANCY TEST at a store, instead of coming to the ER for one. You can use the money that you saved by not buying condoms.

OOOH .. good one. Almost forgot about that one!:smackingf You could also use the money that you just pumped into the vending machines to feed yourself, your significant other & 3 kids.

Specializes in Emergency Room.

1. I only gave you a buzzer because my employer requires me to, please do not use it unless your condition has deteriorated, or you are about to poop in the bed and make even MORE work for me.

2. My name is not "hey you", please address me by name or as "nurse".

3. Knowing my name does not make us instant friends. Using my name will not get you faster drugs, discharged sooner, upstairs quicker, or a meal right away.

4. I know the charcoal you have to drink tastes terrible but keep these three things in mind:

  • I did not create the stuff
  • I did not order the stuff
  • I did not take the drugs that require you to drink the stuff... you did

THEREFORE do not take it out on me by telling me how bad it is,or even worse, spitting it at me or vomiting it in my direction.

5. If you need to go to the bathroom and I bring you a commode, there is a reason. Trust me.. emptying that is not on my high list of things to do today. I'd much rather you trot your bottom to the bathroom. Ditto for the bedpan.

6. To the visitors: I do not care about how this one time you had a similar pain to your loved one and what happened. Or how many stitches you had when you crashed your Amigo at the mall. I am here to care for the patient, not listen to your endless stories. Please... let the patient speak.

7. Do not expect me to remember you from last time. I see many many people each day. I don't mean to offend, but it's hard to remember everyone. It would help if you would lay day, get nekked, put on an ugly blue gown and maybe I'll remember what you were here for.

8. Most important rule: Do not code just before I leave. After 12 hours, I'd really like to go home on time.

Specializes in Emergency Room.

1. If you come to the ER by ambulance, you are going to have to find your own way home when we discharge you.

2. If you come to the ER by ambulance with a splinter in your foot, you will be sent to triage to wait with everyone else. You might as well start working on how you are going to get home now.

3. If you must bring your infant with you for your ER visit, please pack a bag with diapers and formula! What are you thinking???

4. No, I cannot give your boyfriend tylenol for his headache. He has to check in for me to give meds. Now please, forget I said anything about him checking in.

5. Telling us you have an appointment at 2:00 for (fill in the blank) doesn't mean you are going to make your appointment on time.

6. We don't give school immunizations.

7. We don't provide letters for you to prove that your son's lice occurred while in the care of his mother, not you.

8. Trash cans are for trash, not pee.

9. Don't steal all the bandages from the drawers.

10. Your significant other cannot go get you fast food until we get the CT report back for your "stomach ack"

11. If you come in for UTI symptoms, please try to hold it until we have time to get a sample. or ask for a cup! "I just went!" doesn't sit well.

12. Don't call 911 from the ER lobby.

13. Don't call your relatives on your cell phone to tell them we are mistreating you for not completely relieving your pain and them have the call us and threaten us with the old "I know someone!" line. We are not impressed.

14. Don't yell, don't spit, don't kick, don't curse, don't cough in our faces, try not to fart when we are listening to abd. sounds.

Specializes in ER, Peds, Charge RN.
erdiane said:

8. Trash cans are for trash, not pee.

14. Don't yell, don't spit, don't kick, don't curse, don't cough in our faces, try not to fart when we are listening to abd. sounds.

LMAO!

Specializes in Telemetry, ER, SICU.

I just left the ER about 1 month ago (I definitely miss it!) and this post brought back the wonderful memories. Here it goes:D

When at the confessional (aka triage) keep in mind that I do not have Pete the repeat Parrot at the desk to tell you how long of a wait there is

Do not get mad at us because you called the ambulance for hand pain that has been there for 3 weeks and we send you out to triage

Do not lie to me about your recreational activities i.e. smoking, drinking, or illegal drugs, I only ask to make sure all of my boxes are filled unless my chart gets audited

If you appear to be a healthy adult and are not diabetic, do not make it a point to constantly emphasize that you have not eaten all day. It's 5 o clock in the evening--if you haven't died by now, I'm pretty sure you won't anytime soon

I am pretty sure that the sign outside the entrance doesn't say Welcome to the Dentist or Opthalmologist, that's why we can't fix the problem, please see them

Don't threaten to call the manager, it's the weekend, so they won't answer

It is not cute to see your kids crawling on the floor, do you know what fell there a few minutes ago?

You will not start feeling the effects of your pain PILL until about 45 min - 1 hour, so please do not call until an hour has passed

Do not call to see how busy we are before deciding to come--that means you aren't sick

Do not attempt to rush me because you have to be somewhere in an hour. You either wait or leave, our world doesn't operate around you

It's bad enough that you came in for something that isn't emergent, but did you really have to bring your kids in too (of course they are laughing and running around with temps of 98. 6)

Specializes in ER, ICU, Infusion, peds, informatics.

1. Don't threaten me that you are going to leave AMA if you don't get XYZ. You won't like my response. An AMA discharge takes less paperwork than a regular discharge.

2. Don't leave with your iv in. We will send the police out to bring you back to have it removed. And no, you won't be seen then. Unless you check back in.

3. If you are here tonight because you had seizure because you didn't feel like taking your dilantin, don't whine to me about how much the IV dilantin burns. If you don't like the way it feels, take your dilantin. Every day. Or, tell your family not to call 911 when you seize.

4. If you are over 18 and don't want your mother to know that you are pregnant (or have an std), don't argue with me when I ask her to stay in the waiting room. I can't medicate you for/educate you about your diagnosis with her in the room without her finding out.

5. Do not ask me "are you going to keep me?" as I am bringing you back from the waiting room. I don't have xray vision, I am not able to analyze your blood through your skin with my eyes, and I can't read the doctors' minds.

6. I can't help it that the doctor's office told you to come to the er to get your tests done because it would be quicker than having them done as an outpatient. They were wrong. (besides, they were talking about the length of time to get tests results, not the length of time you would have to wait in the waiting room.)

7. I am sorry that your doctor sent you here to have XYZ test done. However, your doctor doesn't work here, and the doctor that does work here doesn't think the test is necessary. Next time, have your doctor give you an RX for the test, and send you to an outpatient diagnostic center.

8. I am sorry that all I have to offer you to eat is crackers and soup. It is 2am. The cafeteria is closed. This isn't Dennys. I realize that you say you haven't eaten in 12 hours, but you have only been here for three, so that is not my fault.

9. If you come in with abdominal pain/nausea/vomiting, and your so sneaks you food, I will have very little sympathy when you start vomiting again.

10. Don't ask me if you can go out and smoke. You are an adult. If you are not suicidal/homicidal, then I cannot prevent you from going anywhere. However, if the doctor goes in to see you and you are out smoking, you will be discharged. And then you will have to start the whole process over again, starting with registration. Seriously.

11. If a joint has been dislocated, kindly hold still while we get xrays and i start your iv. If you won't hold still, I will calmly tell you to call me when you have decided that you have hurt long enough and would like your joint fixed. The doctor can't do anything without xrays, and trust me, you don't wan't him to do anything without an IV.

Specializes in Emergency room, med/surg, UR/CSR.

Don't tell me that you've only had "2" beers when the police drag your butt in from an MVA, you reak of alcohol, and your blood alcohol comes back high enough to make a football team pass out, I won't believe you.

Don't send your grandma in with a dress, full underskirt, and pantyhose on and then wonder why we aren't able to get everything off soon enough for her not to pee on herself.

Oh what memories this thread has brought back. Haven't worked ER in about 9 months and still don't miss the stupidity.

Pam

HAHA - I don't work in the ED, but some of them can apply to ICU patients. Can we post these in the newspaper or somewhere in public? HAHAHA

nursequeenie said:
If you can ask me if you have time to go smoke a cigarette before the doc comes in to see you....your not sick enough to be here.

if you want to smoke, you'll have to sign out ama, go smoke and start all over again.:D

and this is the truth where i work folks! nj is SMOKE free. if you leave to smoke... you're leaving and your room gets quickly filled!

Specializes in ER, ICU, Infusion, peds, informatics.

And for the upcoming weekend:

did you seriously call 911 because you smoked some pot a little while ago and now you feel funny? Seriously? What kind of effect were you going for, then?

Crack tends to cause chest pain. And yes, it can be serious. Life-threatening, even. When I told you the last weekend when you were here that you needed to quit smoking crack, it wasn't because I am personally morally opposed to drug use. I told you that because smoking crack has some adverse effects on your health, and I was hoping not to see you again this weekend.

People tend to throw up when they consume large quantities of alcohol. No, I don't think it was something you ate. I think it was something you drank.

We have a fairly limited drug screen here in the ER. If you think that a friend of yours slipped something into your drink, then I suggest you start hanging out with different people. Because unless it is one of 12 or so substances, i'm probably not going to be able to tell you what you were given, or even if you were given anything at all. And I certainly am not going to be able to tell you who gave it to you.

Do people really order pizza, chinese food, etc? :p Which really gets confiscated and consumed by staff? :p