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.

Rules for the ER (long)

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.

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EDValerieRN

About EDValerieRN, ASN, RN

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Specializes in Emergency Room.

Oh man, this one's going to get good ?

Here's mine.....

1) If you had a room, you would be up there. I am not keeping you in the ER for my health. Trust that the second you get a room assigned and the nurse upstairs will take report that you will be on your way.

2) I do not get paid extra for starting more IVs. I don't enjoy sticking people more than once - it adds to the number of minutes I'm stuck hearing about your stomach pain (and the BK you had on the way here).

2a) No, I can't guarantee getting a good vein on the first stick. See #2.

3) If I am listening to lung sounds, please be kind enough to exhale away from me.

4) Please don't complain about being pulled into the hall. If you're in the hall, you probably aren't dying. And if you are dying and in the hall, at least I will be able to see when it happens to get an accurate TOD.

5) If you come in by ambulance (that you called) don't get upset when I try to put in an IV.

6) If you come in for CP, please don't get loud when I put you on the monitor, stick you for blood and an IV, start O2, get an EKG, and give you aspirin. If you weren't worried about the pain, you shouldn't have come in. PS- you'll probably be admitted to get a stress test tomorrow.

7) No, I don't know if your insurance will cover this.

? If you know what pain meds to ask for, then you know too much and are probably a drug seeker.

9) There is an inverse relationship to the loudness of the vomiting and the actual sickness of the patient.

10) The fact that you are lying in bed moaning does not lead me to believe you are more sick. It leads me to believe that you are more of a pain in my @ss.

11) GET OFF THE %^&$$#&& PHONE!!!!!!!!!

12) If you can breathe well enough to yell at me "I can't breathe" then you're breathing juuuuuust fiiiiine.

13) Just a hint....if you're going to play possum, don't play it in my ED. I can get really personal with a foley catheter really quick. Hey, if you are unresponsive then I want to make sure you won't mess my bed.

14) Just because you or your family member says "I know you're busy" or "I'm sorry to bother you" before making another dumb request (another blanket, when will my room be ready, etc) does not make me less busy or you less of a bother.

15) I am not your glorified personal servant (hell, I'm not a glorified anything).

16) I don't care that you're having pain unless it is in your chest, or related to the leg that just fell off.

17) Is it the flourescent lights in here, or the O2? Because I'm pretty sure you walked to the BR at home and in the WR, and really sure you wiped your own rear end afterwards. Just because you are in the ER does not make you an invalid. (See #15).

18) I don't do anything in the ER for fun (except Narcan ODs - love stepping on buzzes!) so if I ask you a question or ask you to do something, it is for YOUR health, not mine.

I think that's all I have! Does it mean I'm burned out if I haven't worked since Tuesday and still can come up with all of those?

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Oh I love it! These are great.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
Quote

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

  • A cold
  • The flu
  • A stomach virus

Better still, call your provider's office in the morning. You can probably get good home care advice and not expose all those extra people to the viral illness you have. No antibiotic will cure you, anyway, and you can spare other folks the misery.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

Another:

Don't go to the ER with a non-emergent problem if you can't afford to get the ER doc's prescriptions filled. You'll end up back in your primary care clinic tomorrow anyway to get something less expensive, so just make an appointment and save everyone the expensive exercise in frustration.

Can you tell I'm in primary care?

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I've been saying these lately-

i am not your therapist. If i were you'd be in my office paying me triple of what i'm getting here!

How you get home is of no concern to me. Here's the bus schedule. There's a phone in the waiting room to call that friend of a friend who gave you that medical advice yesterday.

If you're a woman, you must pee in a cup before xrays. Cooperate or it'll be a foley for you.

If you order a pizza from your er room it will be seen as a gift for the staff, and the delivery guy has been instructed to bring it straight to the desk for the staff! (the chinese food guy already knows the drill too, so don't call him either!)

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YES, YES, YES!!!!! Every single one of these is SO true!!

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Specializes in OR, ER.

:yeah: Omg... keep it coming guys... love this!

If only I can post this outside triage or maybe print these and hand it over every patient.

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Specializes in Emergency & Trauma/Adult ICU.
TazziRN said:
YES, YES, YES!!!!! Every single one of these is SO true!!

What Tazzi said ...!!!

I had such a day today that I think nearly all the 30-some things listed above applied today.

And just so we not singling out patients & families ... here are a couple that are directed at new residents:

1) If I get a new patient (SOB) by medics, assess her, and page Respiratory ... you can, if you wish, demonstrate to me and the world that you have MD behind your name and I do not by sending the RRT away saying, "I haven't ordered any neb tx." Yep, you can do that. But when you come out of the patient's room and tell the desk clerk to page Respiratory for a 1-hr. treatment, don't get pissed when it takes the RRT a little while to come back. Doncha just hate that bilateral wheezing in all fields that you don't even need a stethoscope to hear?

2) Please do not ask the blind patient what color her stool was, or the pt. with the colonoscopy when his last BM was.

And one more for pts/families: if your PCP told you to come to the ER for 75 gazillion tests ... you're not dying. Next time, insist to this same PCP that he/she DIRECT ADMIT YOU. Then we won't have to repeat these same lovely conversations about how terrible it is that you've been made to wait.

And the top-secret secret ... shhhh ... listen carefully, this is important ...

THERE IS OUTPATIENT MRI & CT WHICH YOU ARE FREE TO SCHEDULE AT YOUR CONVENIENCE.

Thanks very much!

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Specializes in Oncology/Haemetology/HIV.

Add to it:

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.

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Specializes in Radiology, L&D.

WOW! I am not an ER nurse by any means...but I can definitely understand most of these "rules" but do you really not care about pain unless it is chest pain? I am a kidney stone sufferer, and while yes, I know I am not dying from this pain, at times I wish I would so I wouldn't have to feel it anymore. My last stone was 8 mm and I really thought I was gonna pass out from the intense pain, but luckily for me, my ER nurse valued my pain!

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nursie-babie said:

WOW! I am not an ER nurse by any means...but I can definitely understand most of these "rules" but do you really not care about pain unless it is chest pain? I am a kidney stone sufferer, and while yes, I know I am not dying from this pain, at times I wish I would so I wouldn't have to feel it anymore. My last stone was 8 mm and I really thought I was gonna pass out from the intense pain, but luckily for me, my ER nurse valued my pain!

No, we are talking about the pain that someone's had for 4 weeks and is suddenly an emergency at 1800 on Sunday evening.

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