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.

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 Emergency.

These are grear! And so true!

Specializes in NA, Stepdown, L&D, Trauma ICU, ER.
moodychick said:
What about the patient who carries on when you have to start an IV; but they are covered with tatoos and piercings in all places?

K, as a pierced and inked nurse I take issue with that. I've had IVs started a few time, and each and every time they were worse than the things I've had done in the local tattoo parlor. :uhoh3:

Specializes in Clinical Research, Outpt Women's Health.

Good for the nurses that blew off some steam here. It is what allows them to keep going without becoming burned out. Those who were upset about it need to allow them there safe place to do this. It makes them better nurses. This is a place for nurses and they should be supported. Very funny and true stuff also!

Specializes in Pediatrics.

Not an ED nurse (obviously, I'm only an LPN) but I have something to add:

If you shake your baby because she won't stop crying...and now she has...NO, you haven't "fixed" her, now she's REALLY broken!!!!!

*Insight I've picked up while working brain trauma*

Hmmm. . Reading these rules actually makes me want to relearn the old and learn the new--and return to the ER after many years in home care, homebirths, hospice, etc. because you know and I know how important this specialty really is. Years ago, my first post grad position was in an ICU, floating to the ER. I do miss the experience of being totally in that "world." It's exhausting, frustrating yet energizing too. I'm as nervous as a new grad and wonder if I will have the necessary energy at 60. Thanks for a great discussion. Keep on keeping on--we all need you!

Specializes in Critical Care.
Sugar9486 said:
Yes I have worked in the ER and yes I have dealt with these people, so don't tell me that I do not understand? I am a nurse and I do know what I'm talking about. The people that come in for probelms that are non-emergent, yeah they make life hard, but think about it from there point of view.. They are scared.. they don't want to be there... I did not say that I was perfect or any of that, I said that i look at the situation from both sides.

You are not a nurse yet. According to your profile you are a nursing STUDENT. Big difference.

tvccrn

Specializes in M/S, OB, Ortho, ICU, Diabetes, QA/PI.

oops sorry.....

Specializes in M/S, OB, Ortho, ICU, Diabetes, QA/PI.
Sugar9486 said:
Yes I have worked in the ER and yes I have dealt with these people, so don't tell me that I do not understand? I am a nurse and I do know what I'm talking about. The people that come in for probelms that are non-emergent, yeah they make life hard, but think about it from there point of view.. They are scared.. they don't want to be there... I did not say that I was perfect or any of that, I said that i look at the situation from both sides.

You know, I have to hand it to you - in spite of the responses to your, hm, how shall I say, naive opinion, you have the guts/cojones/stupidity to post again. What determination - you obviously aren't one who backs down from a fight - maybe when you really are a nurse, you should use some of that spirit to be an ER nurse. Then, unearth this thread, re-read the posts and see if you can keep your head from bobbing in agreement........

BTW, I've never worked ER but OB in a 90-bed rural hospital where people did a lot of the same stuff plus tried to fake labour so they could be cured of TBP disease (Tired of Being Pregnant) - like the lady who asked the doc in our little Catholic hospital in the woods "Couldn't you just give me an abortion or something? I just can't stand the pain any more!" (she was 26 weeks along and her back was sore - she was perfectly serious.....)

And, as a former Med-Surg and ICU floor nurse, I want to thank the ER nurses for weeding out some of the more crazy people before they hit the floor........

Specializes in M/S, OB, Ortho, ICU, Diabetes, QA/PI.
EDValerieRN said:

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

BTW, did any of those Pollyanna/do-gooder/losers who posted that this thread and the ER nurses who contributed and those of us who aren't ER nurses but laughed our butts off anyway were "mean" even read the disclaimer that preceded the OP's post?

Specializes in Clinical Resource.

After 38 years in the ED, I can say everyone of these is true. I have come up with 3 basic rules that makes everything fall into place.

1. It is the nurse's fault. It doesn't matter if it happened yesterday or 10

years ago or is yet to happen. It is the nurse's fault.

2. You cannot cure stupidity. You can cure ignorance but not stupidity.

3. And those people you cannot cure in rule #2------they breed.

Ok if I offended anyone in the posts I have written I am sorry, that was not my intent. Yes, I'm 19 and I'm a nursing student and I am almost finished with my schooling. I did not mean to make anyone mad or hurt anyones feelings, but I do know the situation in the ER. I have been there as part of my clinical experience and for my job, so I know how it is, I was not speaking about everyone, but I did feel that some of the things said in here were unappropriate and hurtful. Obviously we all have our own opinions and this is the place to voice those opinions. I just figured that I would voice my opinion in the fact that I did think some things being said were unappropriate, I expected some criticism, but I did not mean to offend anyone, so I'm sorry!

Specializes in Oncology/Haemetology/HIV.

Being a student in an ER clinical is not even remotely like working it as a real nurse for 5-10 years. It is also not "working" in the ER at all.

And until you graduate and pass Boards, it is illegal in most places to refer to your self as a nurse. And those that respect nursing as a profession, will not refer to themselves as a nurse until they are a nurse.

I do believe than some people have been unduly harsh towards you at times, and that there has been some name calling, which was inappropriate. But the thread was labeled as a vent, and you should expect that "venting" is what is done there. If/when you become a nurse and have worked (not clinical but actual work), you will understand.

But I strongly suspect that we will be hearing from you in the inevitable "Nursing eats its young", or "Why are nurses so cold hearted" threads.