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.

Specializes in Me Surge.
HopeToBeANurseSoon said:
Not necessarily...I am allergic to pretty much anything besides fyntilal (sorry dont know how to spell it) I am allergic to morphine, dilaudid, and oxycodine so if i need a STRONG pain reliever I think that is the only one I can take. and i am NOT a nurse yet or a nursing student

What has happened to you in your 18 years of life that you have been exposed to these medications? Are you a burn patient?

Specializes in Telemetry, ER, SICU.

I also thought of some more things:

The reason you didn't get discharged with a medication is because you didn't need it...please believe if we had a prescription for STUPID, you'd have it

Don't tell me that you think you are pregnant, when you know you're pregnant because you haven't had a period for the last 3 months and have been nauseated

Do not sit up and tell me that you are dizzy and then attempt to stand up, chances are I won't catch you if you fall... I have another 20years to put on this back

No you cannot have an epidural to be straight cathed--this is exactly why 16year olds should not get pregnant

There is no reason that I should see you several times a week for the same complaint--you're here more than I am and I get paid to be here

Please keep your story straight, do not tell the triage nurse one thing, me another, and the doctor another...it pisses me off:angryfire

If your mother/father has not been bathed for several days, do not expect them to get one while they are here

You don't get the word MAID out of REGISTERED NURSE! I will provide good care for you, but I will not wait on you hand and foot

If you are already on Vicodin/Lortab/Hydromorphone and that isn't controlling your pain, there's nothing else we can do for you, go to a PAIN CLINIC

You have walked past 6 signs that say there is no cell phone use allowed in here, so why are you on your phone

You also missed the no smoking signs, so why are you asking can you go smoke--the answer is NO

Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Ha Ha Ha, welcome to the drive-thru society. Humm, a thought. Fleeting. Drive thru doc, present the problem, give blood, sit in your car quietly, receive results, go home. Wont work, no one to whine to during the wait.

Specializes in ED, ICU, PSYCH, PP, CEN.

Venting is very therapeutic, this is great. Puts me in the right mood to leave for work now.

Specializes in ER.

If you are taking pills best not to identify them by color.

If I ask your allergies and you say "Yeah, some antibiotic" we may have trouble treating your infection.

If you can't remember your pills, at least could you try to remember what you are taking them for? "The doctor gave them to me " just doesn't give me much of a clue.

Relatives who helpfully remind me that the PMD knows, so it should be in our records may be shot. The hospital records and the office records are two different things, and at 3am the PMD will be lucky to know his own name, let alone your entire med list and history.

Specializes in Emergency.

Please don't come by ambulance with a chief c/o earwax--this is not an emergency and certainly not a reason to be brought in per ems.

Don't come in with a hangnail that you pulled off the day before demanding abx because you think it's infected. Also don't get mad when you don't get any meds for it because it's not infected. Don't argue with the medical staff, we can tell if something is infected.

Please oh please DO NOT come in for a pimple to your right nare! This is a waste of everyone's time including yours, however, thanks for the laugh.

If you're going to come in claiming you have a kidney stone stating nothing helps but dilaudid--toradol doesn't help, yet your labs are pefectly normal and you refuse a ct-scan--please don't let me see you at the gas station soon after you're discharged filling up on gas station junk food.

If you come in with a foot problem please do us all a service and clean your dirty, nasty feet first! If not you'll most likely be soaking said foot in a cold bath of betadine for awhile before I touch it.

Oh and my number #1 pet peeve---if all of your tests come back normal and you're not going to die--please don't seem so dissappointed, there is nothing wrong with you, you should be happy! Same goes for you family members who seem sad/mad that there is nothing wrong with your loved one.

If you suspect you have a STD please know there is a planned parenthood right around the corner--please don't use us for your OB/GYN. Also we do not do pap smears here.

Specializes in ER, Peds, Charge RN.

You know, I once heard an idea, I believe on this board, about how to take care of the stupids:

Install a vending machine outside the ER doors. Patient slides insurance card, or just hits a button that says "yeah right I'm not paying," and then makes a selection

Press one for narcotic of choice

a-vicodin, b-percocet, c-dilaudid, d-fentanyl, e-demerol

Press two for work excuse

Press three for pregnancy test

Press four for antibiotic

Press five for personal babysitter/ grandma sitter

Press six and speak into machine for someone to listen to you whine

Press seven and enter in name of medicine for rx refills

Wouldn't that save so much of our time and money? I bet there wouldn't be a nursing shortage anymore :specs:

Specializes in Emergency & Trauma/Adult ICU.
EDValerieRN said:
You know, I once heard an idea, I believe on this board, about how to take care of the stupids:

Install a vending machine outside the ER doors. Patient slides insurance card, or just hits a button that says "yeah right I'm not paying," and then makes a selection

Press one for narcotic of choice

a-vicodin, b-percocet, c-dilaudid, d-fentanyl, e-demerol

Press two for work excuse

Press three for pregnancy test

Press four for antibiotic

Press five for personal babysitter/ grandma sitter

Press six and speak into machine for someone to listen to you whine

Press seven and enter in name of medicine for rx refills

Wouldn't that save so much of our time and money? I bet there wouldn't be a nursing shortage anymore :specs:

How about candy dishes on the counter at the nurses station: one with Vicodin tabs, one with Percs, and one with work excuses?

the sponge that's used for birth control is *not* the same cello sponge you use for the dishes. that's why you can't get it out now.:bugeyes:

yep, the idiot of the year award did this one a few years back! ... should've seen the thing when it came out!!

holy.........

Specializes in Med-Surg, ER, TRAUMA!!.

Amen!!! You took the words out of my mouth!!! I wish all us ER nurses could post this in EVERY ER in the country. Also, it's SO nice to get a think it will frequent flier for pain meds. Don't think that you will get better drugs if you threaten or berate the ER physician. They don't consider that "constructive criticism"!!

Specializes in Orthosurgery, Rehab, Homecare.
MLOS said:
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.

Planned parenthood will even do one for FREE and you won't have to wait 6 hours and piss off the staff.

~Jen

medsurgnurse said:
What has happened to you in your 18 years of life that you have been exposed to these medications? Are you a burn patient?

I wondered the same thing but didn't want to be the one to say it....