Rules for the ER (long)

[EDValerieRN]

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.

[Medic/Nurse, BSN, RN]

?

ENOUGH ALREADY!

This was to be a thread for a little venting and humor. It turned into a thread where a few decide to judge and condemn those ______ (pick your word - there have been many listed) ER nurses!

LIGHTEN UP!

I have been at this for 15 YEARS! And I am a terrible nurse?! I do take great pride in providing a level of clinical excellence to my practice. I am also generally - kind, compassionate, discerning, empathetic, interested, supportive, understanding and dedicated! But I am also - exhausted, abused, victimized, traumatized, deceived, skeptical, trivialized and fed up at times!

Is is too much to expect that folks will conduct themselves with a bit of respect, decency and common sense? The standards of polite behavior and good conduct are eroded in many places. (the ER is one of 'em)

The emergency department has become the "catch all" for all.

If you are in a life/limb threatening state I will assure you a full on, all out response! If you are not, I will get to it! I have to use very little of what I know on a regular basis. 90% of what I see in the ER could be taken care of in the office/clinic setting or should not need to be seen at all. So I remain at the ready with my MSN near completion and clinical certifications /courses of CEN, ACLS, PALS, NRP, TNCC, ENPC, BTLS - just ready for your "emergency". I estimate that among of the other 10%, only 3% of those are actually emergent. But, I'm ready.

Advice to Sugar9486 - You do not know what you do not know! It is real EASY to have passion, compassion and a pollyanna view of nursing and just how selfless & dedicated you are going to always be as a nurse no matter what - when, you are not in those shoes! Report back after you've been at it awhile! I, personally - will not be in the field of nursing much longer. I am just full up on allowing myself to be treated in the disrespectful manner that has become a common practice. I have standards for how I treat others and expectations for how I am to be treated. I am just done!

I think that society has a mentality that it has to be NOW. I want what I want when I want it - and nobody better get in my way of it! I have even been referenced as a waitress.

I also had a patients mother (while pointing a finger in my face) direct me "that you make it your business to see that my son gets a room - that is what MY insurance is PAYING you to do. Do you understand?" This from the mother of a 16 year old with known kidney stone that failed P.O. pain medications (from vomiting) that had been waiting to come back for 1 1/2 hours. I had 5 other fairly sick patients all requiring a monitor - and did get a hall bed open. I knew it was not ideal, but I apologized as I brought them back and explained that at least I could get an IV and some medication for the patient. The the mom felt in necessary to "put me in my place" and remind me "who I was working for". At the end of her admonishment I did offer them a return to the waiting room and an assurance that when a private "room" became available and the patient (her child) was at the top of the acuity I'd let her come and approve it and we could treat the patient then - her choice! I will always support a patients right to choose! (She decided that maybe a hall bed wasn't that unacceptable then!)

This is a tough job in a tough world - let's all just try to take it easy!

[tryingtomakeit, RN]

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!

Heck, you don't even have to stop on the way - if you have any lying around your house, car, etc. that are chewable and have nothing green growing on them, I would give ya my keys! Most nights just to have enough time to smell them would be awesome!

[ItsyBitsySpider, BSN, RN]

NREMT-P/RN said:

ENOUGH ALREADY!

This was to be a thread for a little venting and humor. It turned into a thread where a few decide to judge and condemn those ______ (pick your word - there have been many listed) ER nurses!

LIGHTEN UP!

I have been at this for 15 YEARS! And I am a terrible nurse?! I do take great pride in providing a level of clinical excellence to my practice. I am also generally - kind, compassionate, discerning, empathetic, interested, supportive, understanding and dedicated! But I am also - exhausted, abused, victimized, traumatized, deceived, skeptical, trivialized and fed up at times!

Is is too much to expect that folks will conduct themselves with a bit of respect, decency and common sense? The standards of polite behavior and good conduct are eroded in many places. (the ER is one of 'em)

The emergency department has become the "catch all" for all.

If you are in a life/limb threatening state I will assure you a full on, all out response! If you are not, I will get to it! I have to use very little of what I know on a regular basis. 90% of what I see in the ER could be taken care of in the office/clinic setting or should not need to be seen at all. So I remain at the ready with my MSN near completion and clinical certifications /courses of CEN, ACLS, PALS, NRP, TNCC, ENPC, BTLS - just ready for your "emergency". I estimate that among of the other 10%, only 3% of those are actually emergent. But, I'm ready.

Advice to Sugar9486 - You do not know what you do not know! It is real EASY to have passion, compassion and a pollyanna view of nursing and just how selfless & dedicated you are going to always be as a nurse no matter what - when, you are not in those shoes! Report back after you've been at it awhile! I, personally - will not be in the field of nursing much longer. I am just full up on allowing myself to be treated in the disrespectful manner that has become a common practice. I have standards for how I treat others and expectations for how I am to be treated. I am just done!

I think that society has a mentality that it has to be NOW. I want what I want when I want it - and nobody better get in my way of it! I have even been referenced as a waitress.

I also had a patients mother (while pointing a finger in my face) direct me "that you make it your business to see that my son gets a room - that is what MY insurance is PAYING you to do. Do you understand?" This from the mother of a 16 year old with known kidney stone that failed P.O. pain medications (from vomiting) that had been waiting to come back for 1 1/2 hours. I had 5 other fairly sick patients all requiring a monitor - and did get a hall bed open. I knew it was not ideal, but I apologized as I brought them back and explained that at least I could get an IV and some medication for the patient. The the mom felt in necessary to "put me in my place" and remind me "who I was working for". At the end of her admonishment I did offer them a return to the waiting room and an assurance that when a private "room" became available and the patient (her child) was at the top of the acuity I'd let her come and approve it and we could treat the patient then - her choice! I will always support a patients right to choose! (She decided that maybe a hall bed wasn't that unacceptable then!)

This is a tough job in a tough world - let's all just try to take it easy!

So well said. Thanks.

[Sugar9486]

i have been in the ER and I know quite a few people who work in the ER and agree with me, so you can all get off your high horse and give it up.. if you want to talk badly about your patients thats fine we all need to vent one way or another, but when it comes down to comments where the patients really can't help the situation, then you need to stop, it's not fair to them. If you don't like your job, then quit... whoever said you wouldn't have a job without your patients was right...

[andhow5, BSN, RN]

Oh, another one, regarding visitors with the patients...

I don't care if you're an EMT, Paramedic, Nurse, CNA, Doctor, Student Nurse, whatever - I know what I'm doing, I'm good at my job, now back off or you'll be removed from the clinical area immediately. Don't tell me what needs to be done, how it needs to be done, what IV to use (I despise hearing, "You have to use a 'butterfly' because her veins are so small" - that will guarantee a 14-gauge IV), et cetera.

And if you don't back up off me, give me space to care for MY patient, and quit breathing down my neck, you will be removed immediately, because what YOU perceive as making sure your loved one is cared for, I perceive as interfering with my patient's care.

I can understand being nervous and worried, being concerned about their loved one, but give it a rest. My patient comes FIRST and before any of the visitor's concerns are addressed (unless a minor - then the guardian gets attention at the same time). If you can't accept that I am putting the patient first, I promise that you WILL be bounced immediately.

[LeahJet, ASN, RN]

Sugar9486 said:

i have been in the ER and I know quite a few people who work in the ER and agree with me, so you can all get off your high horse and give it up.. if you want to talk badly about your patients thats fine we all need to vent one way or another, but when it comes down to comments where the patients really can't help the situation, then you need to stop, it's not fair to them. If you don't like your job, then quit... whoever said you wouldn't have a job without your patients was right...

[TazziRN, RN]

Sugar9486 said:

i have been in the ER and I know quite a few people who work in the ER and agree with me,

No, no, no......you have never WORKED in the ER, so you do not have the right to judge what we say when on our own time. And "I know quite a few people" doesn't mean a thing.....they need to speak for themselves before their opinions are even considered. I know people too, child, and they all have many years' experience as ER nurses, and they feel the same way that I do. And I will bet that the kind of ER nurses I know far outnumber the kind that you know!

[andhow5, BSN, RN]

Sugar9486 said:

i have been in the ER and I know quite a few people who work in the ER and agree with me, so you can all get off your high horse and give it up..

Have you been in the ER as a NURSE? Have you had to deal with ANY of what we're venting about? How do you deal with having someone tell you to, "Shut the F up, that unless you do what I say right now and give me the medicine I want, I'll kick your @$$ and then wait for you later and kill you!"?

And for the 'quite a few people' that you know that work ER that 'agree' with you - how long have you known them and how WELL do you know them? Are you sure they weren't agreeing with you to shut you up?

I'm afraid you're looking at things with rose colored glasses on. The way you say we should be is ideal, to be sure, but not the way things are in the real world. We do not sit around and spitefully, purposefully think, "Gee, who can I trash right now?"

You can not dictate to us how we can debrief and de-stress. Telling us how to be is arrogant in the extreme. You are the one right now that is on their 'high horse'. This forum is for EMERGENCY NURSES to address their concerns in their chosen specialty, not for students to come in stating how horrible we are for venting.

I promise you that it is much better for us to vent here, in a completely safe way to other people that understand what we're going through than to bottle it all up and take it out on the next fool that crosses the line of decent behavior.

And when you can care for a pediatric patient that dies as a result of abuse (despite coding them for what feels like forever), tell the parent, "I'm sorry, but your child is dead despite our best efforts", and you have to go to your next room and clean up the injuries of the abuser that resisted arrest and the police brought in for medical clearance before taking them to jail - THEN you come back and tell us how horrible we are for venting.

[ZASHAGALKA, RN]

Sugar9486 said:

Just because the nurses feel that the nonemergent case should wait does not mean that all people agree with them.

Ok, had to comment on this one from several posts back. (Sorry, just read the thread.)

It's not that we feel that non-emergent cases shouldn't get treated. Just not in an EMERGENCY room.

By DEFINITION, non-emergent isn't an emergency.

As an ICU nurse that used to frequently float to ED, I totally get this thread.

1. Kid is active, happy, bouncing off the walls at 2am.

"What's the matter tonight?"

"Kid threw up."

"How many times?"

"Once."

"What were they doing before they threw up?"

"Sleeping."

"Before that?"

"Oh, he was fine before bed."

"So let me get this right, you're kid was asleep, woke up, threw up once, and is fine now, and you brought him out to the ED at 2am?

"Yes. . . Who get this?" (handing me the kid's Medicaid Card.)

(Under my breath), "We all do."

2. You can't beat the woman that waited hours to get a script for a 1.50 bottle of OTC motrin so that 'Medicaid would pay for it'. Hmmmm. They don't. Boy was she tweaked! "How am I gonna afford it then?!"

(again, under my breath) "Try spending less on the 'do and two-tone nails."

But alas, I suppose that makes me unsympathetic. But see, in either of these cases, if stupidity would compel me to seek treatment, my $100 ED co-pay would cause me to re-consider. I honestly think that Medicaid/Medicare should be subject to a $100 co-pay for ED visits, garnishable from wages/welfare checks.

If it's a true EMERGENCY, 100 bucks is a bargain, for anyone.

Of course, some of those idiots would let their kids die rather than spend 100 bucks in a TRUE EMERGENCY. And THAT is why that plan would never work.

You understand that there is a DISTINCT difference between the people being discussed in this thread and those w/ TRUE EMERGENCIES or valid 'I'm willing to pop for the 100 co-pay to be on the safe side' concerns.

All too often the root cause of ED abuse is an 'entitlement' society. Society owes me, man. Whatever.

~faith,

Timothy.

[ZASHAGALKA, RN]

I forgot. My co-pay went up to $125.

~faith,

Timothy.

[kstockdaleRN]

I am not an ER nurse, but I have enjoyed reading this thread. Many of those "society owes me" people end up on the floors for DAYS. :) A lot of this thread applies to many areas of nursing, although we are not dealing with traumas at the same time. I personally take offense to nursing students who have not learned "real world" nursing yet stomping on the good time in here. :) Many of us can't go home to our families and complain about our day all the time - trust me, they get sick of it fast! This is a great place to vent with (mostly) like-minded people!

Don't get me wrong, I love student nurses - I enjoy teaching what I know, and precepting. But I too learned what happens in the real world very quickly after nursing school - NANDA diagnoses don't apply here. Writing out complicated 10-page care plans doesn't apply here. Learning to organize quickly, prioritize, and do a lot of technical skills, a lot of charting, and a lot of social work with no break and hurting feet is the reality of it all. Nurses, like other jobs that continually deal with the public, learn to be quick judges of character, and trust us, we've seen it all.

My hats off to ER nurses - you do it all, and you do it well.

[Ruby Vee, BSN]

sugar9486 said:

I have been in the er and i know quite a few people who work in the er and agree with me, so you can all get off your high horse and give it up.. If you want to talk badly about your patients thats fine we all need to vent one way or another, but when it comes down to comments where the patients really can't help the situation, then you need to stop, it's not fair to them. If you don't like your job, then quit... Whoever said you wouldn't have a job without your patients was right...

Look, I'm sure you're very idealistic and compassionate and perfect and all -- but what you're not is a nurse. So get off your high horse. Until you've been a nurse and actually experienced what these folks are talking about, you don't know what they're talking about. Worse, you don't seem to get that you don't know what you're talking about. You look like an idiot. A judgemental, self-righteous idiot. I'm surprised these er nurses have been as nice to you as they have been. Grow up already!