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]

Sugar9486 - Sweet Pea! You have represented yourself as a nurse in an earlier post. Are you a student, nursing student, ER clerk, nurse aid, patient care assistant, nurse (LPN, LVN, RN, RN-BSN) ??? Just what credentials do you speak from???? You think all (or just you) are scared and needy - good luck savin' em all! (IF you get the CHANCE)

It is a good thing that your ID is obscured - because I would promise your 19 year old idealism would not make it out of my course or clinical rotation!

Good thing you have an outlet for it here (and get to vent), because I'm CERTAIN that your frames of reference would NOT be looked at in a favorable manner by any program. If (???) you make it out, do us all a big favor (and yourself one too) DO NOT darken the ED door!

I know "WE" don't need ER nurses that bad -

? ?

[68RN]

It was hard for me to read to many of these posts, as I was one of those patients who frequented the Er regularly for girdle like pain around my midsection.This went on for several years and I was informed one time by the ER doc that "It costs hundreds of dollars to run tests." This was at the hospital I worked at for 11 years. One time my CPK was elevated and the doc asked me if I had any muscle damage lately?? I had numerous surgeries and developed acute pancreatits more than once. I finally found a good internist and diagnosed me with fibromyalgia and then after a few months of watching my autoimmune problems sent me to a rheumatologist. I have spondylitis as a result of undiagnosed microscopic colitis and my spine is beginning to develop bamboo areas associated with ankylosing spondylitis. I am almost 59 years old and had to give up my nursing career 3 years ago due to many joint problems and pain problems. I also had 2 knee replacements and they are keeping me moblie. I am on methotrexate and will start the injections next week at 25 mgm which is as high as I can go with the methotrexate. the next level drugs are much more expensive.

I think if someone would have taken my pain a bit more serious, perhaps I could have gotten an earlier diagnosis. The fibromyalgia part I think developed after years of undiagnosed pain and wore down my CNS.

I also had a horribly stressful job as charge nurse on night shift on an inpatient rehab unit. I beganto want to be by myself and have trouble with dose calculations. Really scary stuff. I went into a deep depression and remain on 300 mgmg Effexor daily along with Provigil 200 mgm to helpwith the overwhelming fatigue that comes with both fibo and spondy.

Please remember that some of those pesty patients might have an autoimmuine disease and might just need a referral for more in depth study. And yes, I went to numerous docs until I found this wonderful internist. I have not made a trip to ER in over three years!!!!

And to those nurses who showed extra compassion and perhaps a smile, thank you!!You will never know what it meant to me, as I was beginning to question my own sanity.

I miss my bedside nursing and it has been rough to learn to take care of myself. To the young nurses, please remember that some of the patients who seem to be frequent er patients might really have a serious condition.

While visiting my son in Colorado a few years before my diagnosis, I developed that hard girdle like pain around my midsection and went to the Fort Collins Hospital. Well. one nurse just buzzed in quickly, gave me a funny look and said, Oh you are the nurse from out of town"!!!! Self explanation!!

And yes, I see your side about the crazy people you deal with every day and know you have to vent. But to know you all laugh at us is so upsetting!!!

I hope none of you have to walk even for 5 minutes inmy shoes. It might soften you up a bit!! Thanks for letting me vent!!!

[Medic/Nurse, BSN, RN]

Glad you got to vent 68RN and I am truly sorry for all that you have been through ~

Make no mistake! I take pain very seriously - and I would like to say never, but I've been at this a while - have I just ignored a prospect of a legit patient complaint of pain. I will, consistently and quickly, go to task with the MD's to ensure we are doing the right thing for the patient.

There are patients that have "played me like a ____ (harp, fiddle, fool)" but oh, well - ! I can live with that! What I can't live with is allowing a few that abuse us/the system to allow a jaded view to all!

I'd rather 10 that play me get the goods, than allow any ONE to lay and suffer for it. That being said, if a patient hits my ED, time and time again - the pain, the pain! Yes, your care will be consulted with pain management and the ED will NOT be the source of other pain management medications.

But, I am still nice and do all that I can - as do most ED nurses I've ever worked with!

Good luck to you and I hope for your health to improve, you did your time (that nursing thing) I can not imagine that other nurses would be less than than stellar in their care of you. I'm sorry for what you have been subjected to - there is no excuse!

[TazziRN, RN]

68, it sounds llike you experienced what you did before pain management became the fifth vital sign. I, too, take pain seriously, especially in someone who has made attempts outside the ER to find the source or to find a good management plan. This thread vents about the ones who come in when they run out of pain meds on Friday evening, or who have had the pain for a week (or more), have not seen their docs, and come in at 1800 on Friday evening. And I think it would be safe for me to assume that when you experienced your pain you weren't asking for a sandwich.

I'm so sorry that your problems have cost you your nursing job, I can't imagine how I would feel if that happened to me.

[LeahJet, ASN, RN]

68RN said:

I was informed one time by the ER doc that "It costs hundreds of dollars to run tests."

I think a misunderstanding in the general public is that a diagnoses is their right when they are discharged. The ER rules out life threatening problems and then deals with the here and now....(pain). To get a diagnosis means following up with your primary MD and then he/she refers a specialist.

I am sorry that you have dealt with so much...but I think that ER doc might have been talking about diagnostic tests that would have been more appropriate in an out pt. setting.

[anichols]

i want brownie points!!!...got myself two borderline disorder pts who are threatening to write me up for not sending them to er last night for "chest pains" (right after overhearing them discuss how "they always have to send us out of we say that because it could be serious and you'll get some kick-@$$ meds, man...i got morphine one time"). both w/ perfectly gorgeous and stable vitals (despite repeated checks--"the dynamap is broken, take it again"...okay, fine, but my fingers and ears aren't and you're still stable!), changing descriptions of pain and locations...oh, and lest i forget..."i have a history of heart problems (but no dx and got a couple of ecg's right here they've taken since some other nurse who didn't want to keep playing with them keeps sending them out...oh, look! normal, every last one of them!). and my favorite of the night: "i need to go to the hospital i'm sick!" (yes, you are...that's why you are here. and this is a hospital. or maybe it's 'cause i'm a psych nurse that i somehow didn't get trained in assessments or vitals or ever work a "real" hospital like every other nurse out there?) like ya'll er nurses to much to give you the hassle of my attention-hungry drug seekers....so do i get my brownie points now?

now, what was that bit about people who go to er all think they really are having an emergency and nurses are bad for not understanding that?....

oh--both survived the night just fine, just as healthy in the morning, and were pissed i put them on extra checks overnight for medical reasons just in case "because that may affect our pass privilages if the treatment team finds out...you won't chart it, right?".....:angryfire

[caroladybelle, BSN, RN]

68RN,

My regrets on your illness.

Despite that, ER nurses DO need to vent and this was clearly labeled as such. It is intended to allow them to do that. It also lets us know that they may say things that harsh to many of us (as previously noted, they are things here that I do not agree with) and we have the option NOT read them.

I regret that you feel "made fun of", but whether the nurses say these things out loud, write them on this BB or not, many of them ARE THINKING THEM!!!! And they should have the right to discuss them, without others pointing out how "mean" they are.

Be assured that many of those "compassionate, caring" nurses that you are thanking....are probably represented here, or have thought the very things expressed here. Being able to express them is what allows them to continue being compassionate.

I will also tell you there are plenty of nurses (also on this thread) including myself that have had difficulty with being diagnosed with autoimmune disease. WE HAVE WALKED IN YOUR SHOES. It often hinders us in life in unpleasant ways. And I will still do anything to not go to the ER because IT IS NOT A PLACE for diagnosing or treating it. It is a place for emergencies only, not one for treating a chronic disorder, and should be used as little as possible for autoimmune disease.

[suzyskinurse]

I was on my way to what was supposed to be my first day of nursing school when I was hit head-on by a drunk, who pinned my Isuzu Trooper up against a stone wall with his Jeep Wagoneer. Luckily, the family nearby was home & had an extinguisher to put out my engine fire.After pulling my IV's out twice on Life flight & having grand mals, I made it to the trauma center, where I could hear people talking about me. Your First ER Rule should be:

Remember, your patient may be bleeding profusely, fractured, incontinent, delirious & often unresponsive, BUT We Can Hear, & often remember. Please don't make doomsday pronouncements.. if it wasn't for a few nurses & Drs, my 2 sons would probably be motherless now. Although I don't remember seeing anything until my 3rd day, I Heard, & Desperately hung onto some of the words of My Heroes. Not ALL ER patients are there by choice!!

[suzyskinurse]

Why not? The second time I had a chi ld they made me go to the hospital (I wanted the birthing center) & I signed out AMA 3 hours after. Best day I had with him!

[TazziRN, RN]

suzyskinurse said:

Why not? The second time I had a chi ld they made me go to the hospital (I wanted the birthing center) & I signed out AMA 3 hours after. Best day I had with him!

Wow......you deserve kudos for that! I, on the other hand, wanted the pampering that I got for the three days I was in, 'cuz I knew that once I left the campus, "pampering" would just be a word in the dictionary!!

[EDValerieRN, ASN, RN]

I have another few after working again:

If you came here for a stupid complaint, you can get yourself home. I'm not a taxi service, and I'm not going to give you a cab voucher. When you go to the grocery store, do you demand that the clerk find a way for you to get home? No, you don't. You find a way. I'm already paying for your healthcare, I'm not paying for a cab as well.

If you swing at me, you had better have a neurological problem or you will be arrested. Period. Don't be suprised when the cops show up. I told you I would call them, and I called them.

Staring at me does not make the lab results come back any more quickly. Go stare at them instead (I wish).

If you come to the hospital because you think you broke your neck, do not take off your c-collar.

[JessicRN]

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

If you came to our ED saying I can't take dilaudid morphine or codiene we would definitely not think you are drug seeker. A drug seeker says " am allergic to asa motrin and toridol. Reglan makes me feel funny and benedryl makes me nauseous.Only morphine and lots of it helps my headache,really."