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 ICU,ER.

Oh, and isn't this just like ER nurses.....

We pause to deal with the crap (criticism and upheaval) and just get on back to business............;)

Specializes in ED-CEN/PACU/Flight.

:lol2:

Ah well... Those that criticize us obviously don't have a clue and won't ever have one!

Specializes in NICU.
andhow5 said:
No, we can NOT call in refills for you, we're an ER, not a clinic.

I don't work ER, but we have parents calling the NICU sometimes asking for refills of prescriptions. We always tell them to call their pediatrician, even if it's in the middle of the night - we aren't legally responsible for these babies after discharge.

HOWEVER...

Last week a dad showed up on the unit one night asking for a refill on his daughter's prescription. He didn't want to call the pediatrician because it was midnight and he knew we'd still have a doc awake anyways, plus it was a surgical ointment and they hadn't yet seen the peds surgeon outpatient. Our on-call doc really shouldn't have written the script, but it was on a kid that had just been discharged a week ago and the dad at least came in instead of calling.

Though I think it had more to do with the fact that the dad brought four dozen hot fresh donuts up with him as a thank-you...

Now THAT kind of behavior is VERY accepted!

Specializes in ER, OR, Cardiac ICU.
Quote

Though I think it had more to do with the fact that the dad brought four dozen hot fresh donuts up with him as a thank-you...

If that happened in my ER, I'd walk him over to the Pyxis and ask, "So, what do you want & how much?"

Specializes in Nephrology, Cardiology, ER, ICU.

I think we all agree that ER nursing is stressful and not knowing what is coming in the door can be doubly stressful. We deal with folks at their worst - going through a crisis or at least believing they are.

This thread was not meant to be totally serious - its a way of letting off steam. Please do not take everything you read at face value.

Specializes in NICU.

Okay, so next time I have a kidney stone and want the sweet relief of IV Toradol...

Step 1: Get in the car.

Step 2: Stop at Krispy Kreme.

Step 3: Proceed to the ER.

Gotcha!

Gompers said:
Okay, so next time I have a kidney stone and want the sweet relief of IV Toradol...

Step 1: Get in the car.

Step 2: Stop at Krispy Kreme.

Step 3: Proceed to the ER.

Gotcha!

Honey, for Krispy Kremes you get Dilaudid!

Specializes in Emergency Room.

What is it with people and food/water?

All my trauma pt wanted yesterday was water (from the second he came through the doors). Even though I told him at least 10 times he couldn't (fx tib/fib and probably OR time later that day) he kept whining. THE MAN WAS 50!!! His wife kept coming out of the room to ask if he could have water. NO. Did he fracture his ears too? We had a very particular ortho surg on yesterday and he will tear you a new hole if you give his pts any fluid (including mouth swabs). I let him moisten his mouth with a damp washcloth - that I wrung out all the way - but still kept complaining. My feeling? I'm thirsty too. Haven't had food, drink, or bathroom all day. In fact, I'm finally sitting down. So suck it up, and think about the pain in your leg if the urge to drink gets too great.

What do I actually say? Sir, we have 2 IVs running in you right now; no one ever died from hunger or thirst in the ER. (Except the ER RN)

And another wonderful pt.....18 y/o girl, sexually active, on the pill. LMP "about 3 or 4 weeks ago" stopped taking her pill on Tues because "I think I'm pregnant"

Me: What makes you think you're pregnant?

Pt: I don't know, its just a feeling I have

Me:Have you ever been pregnant?

Pt: Well, no.

Me: And what's going on now?

Pt: Well, I was kinda having sex last night and started bleeding.

Me: Okay, what did it look like?

Pt: Like period blood.

Me: Oh. Do you have any cramps?

Pt: Yeah, I thought with the blood and cramps I might be miscarrying.

Me: Okay. (Go through A&P of reproduction with pt)

Me: Now, with what I just explained to you, what makes you think you're pregnant?

Pt: Its just a feeling I have. Oh, and when I pee, I feel like I'm having an orgasm.

Me: Mouth wide open....

Later, when I was straight cathing her (with an 8 fr cath). She starts to do that crocodile tear thing and screams "I can't be a mom now! I can't be pregnant." I just finished and left the room. Drama.

She came in by ambulance.

And she wasn't pregnant.

Specializes in NICU.
TazziRN said:
Honey, for Krispy Kremes you get Dilaudid!

?

I never got anything narcotic for my stones. Maybe it was because the first time I came down to the ER at 3am during my shift, in surgical scrubs, with my then undiagnosed stone pain and they didn't want to be giving a staff member narcotics. But when I returned 24 hours later from home, in even greater pain, and specifically asked for Toradol, I swear I almost had to pick the nurse's jaw up off the floor. What can I say, it was wonderful stuff! I'm SO sad I can't get it when I'm in labor. :(

Specializes in ER, Peds, Charge RN.

The only thing worse than bringing three suitcases is bringing three children.

The volume of your voice is inversely related to your acuity.

It is not my responsibility to get you a cab. Especially if your cab is going back to your box two blocks down the road.

Don't yell at me about the wait times when you are the one who beat up your wife. I didn't hit her. You did. You are the reason you are here.

And for the PCP's: Don't you dare send your patient in for an "emergent" MRI. Outpatient MRI's exist for one reason: to do outpatient MRI's. Utilize.

Specializes in ED tech on a resp. therapist adventure.

You are not kidding about not bringing the kids!! We had a couple the other night come in with their 2 year old in tow who was wearing those shoes that squeaked (on purpose) everytime she walked...cute...Argh..... Just about drove us nuts!

Specializes in Burn ICU, Psych, PACU.

Aren't opinions like bumholes, they come in all shapes and sizes, sometimes they're stinky, and last, but not least...everybody's got one? I'm thinking, hmmm, maybe lighten up...isn't nursing is serious enough without bumming out on a thread merely meant to help people...hmmm, maybe lighten up?

I hope this doesn't get me in trouble!