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.

[twotrees2]

nurstoi13 said:

Hello all, I am starting nursing school this fall and I am very excited. These postings are very funny but it makes me a little nervous. I guess after so many years in any job you will have some complaints.

The way i try to look at "jokes" such as we see here and have seen elsewhere is this - there is maybe a bit of truth - some ( or maybe a lot lol) exaggeration and a good laugh and maybe even a lesson or example to pay attention to warn you lol in it - that way i dont get offended as easily because i know that someone somewhere has had some form of the joke and i try to picture it - sometimes there is nothing funnier than real life - and if ya cant find the humor you'd only want to cry a lot and its better to laugh. Dont be nervous - one day you will make up your own joking and make many laugh ( of course lol - i do find that unless its someone in the medical field they dont always understand the joke and may be really offended or look at you like your nuts lol) - smile - its a great day:)

[Nurse-o-Matic]

When I bring your PO pills in a nice little fancy mini cup, please simply lift the cup to your mouth and dump them in. DO NOT dump the the pills out of the cup into your hand onto the bed sheets or onto the floor. Why is it that 9 out of 10 people have to dump the pills right out of the friggin little cup? C'mon people!! :angryfire

Don't tell me that your normal temp is 96 so the 98.6 I just took is a high fever for you. (No one ever says their normal temp runs high so they don't really have a fever)

When you come in with a chief complaint of a groin rash/genital problem/butt abcess, please don't argue with me and wine about having to put a gown on. Especially a problem with the guys... Sheesh.

If you are not the patient, please stop answering the questions I ask To the patient. You don't know if grandma's pain radiates anywhere or if she is experiencing relief from the pain meds. Also, if you are not the patient, I could care less about the kidney stone you had 3 years ago and what medicine helped you.

[twotrees2]

that reminds me of a very funny story with my now 23 yr old son - when he was one and when he was 2 - twice - both times in major dont go out unless you have to snowstorms with the nearest hospital 25 min away - he screamed and screamed ( on a weekend) - nothing i did all day and night helped including having my mom come and help me - you'd swear he was sick - he wouldn't eat - wouldn't sleep - just screamed - went for the ride - screamed all the way - got to the er - screamed right up until the cute nurse came in - lolol then all he did was play!!! :) - thank god both times i had very understanding nurses and a very patient mother ( i was very young and naive lol) i swear - that was the start of his liking pretty nurses - so far he has dated 2 hahaha. boys. thanks for letting me share - just a fond ( or not so fond depending on how ya view it lol) memory with my kid and mom.

[twotrees2]

schooldays said:

Oh, I know you just had a bad day and all, but I would take issue with #5. There is actually substantial disagreement within medicine whether the symptom of moderate fever in children should be treated with antipyretics. Furthermore, a child who already has a high fever is at very low risk for a febrile seizure. Febrile seizures most often occur when fever comes on quickly and spikes quickly-often before anyone even realizes the child's temperature is above normal. And lastly, febrile seizures rarely cause any lasting damage, other than scaring parents to death. I find it questionable whether children should routinely be medicated at the first sign of fever just to prevent them.

Again, I know you said you just had a bad day. But I also think all ER workers should remember that patients can and will vote with their feet based on word of mouth about ER experiences.

I rarely give my kids Tylenol or anything for fever unless they are extremely lethargic and unable to drink or are uncomfortable - i would say though that - as for the typical "layman" patient yes these jokes would probably be very disconcerting- however that's why its kept between our field or close friends who may understand - i dont expect anyone that has posted would really really go tell their patients these things - its just a stress buster between us - ?

[Nurse-o-Matic]

So, there I was... feet throbbing, back aching, bladder distended and screaming for relief, stomach rumbling, eyes dry and scratchy, mouth and lips dessicated and cracked from 10 hours with no fluids, uniform damp with perspiration and splattered with blood from a flailing demented man 2 hours ago (okay, also maybe a little bit of a white deodorant stain begining to show around the armpits). I stumble onward, though, proud to be on a mission to deliver the little, fancy cup of PO meds to a sick granny. A smile on my face, but not so big as to cause my dessicated lips to crack and bleed, I explain the medicine to my patient and gingerly pass the cup into her ever so eager hands. "Just lift the cup to your lips and dump in the pills," I say, coaxing her softly. Granny nods, smiles back, then takes a priming sip of the ice water as I secretly fantasize about thrusting the water to my own lips for a few greedy gulps. I look back at Granny and nod. She's ready to take the pills....a dramatic pause....and then.....NOOOOO!!!!! Too late! She has already disobeyed and is now overturning the little cup of precious pills into her gnarled, arthritic, coumadin-bruised, parkinsonian-tremor hands! I dive to the bedside, a desperate attempt to at least keep the pills somewhere on the bed. "Ooops!" She says with that cute little old lady giggle. I am able to recover the pills and place them back, safely, into the cup. Phew, a close one. Still patient, I reach to hand her the water but when I turn around, the greedy gnarled fingers have already been digging in the cup trying to get the pills out! The white pills (it's always the white pills) have bounced out and onto the bedsheet! "Don't move", I instruct as I search for the missing offenders. This is when granny's family crowds in and starts moving the bed up and down and flipping the sheets around to "help." The pills start plinking musically to the floor right at that moment. I sigh and go to see what pills are left in the safe little cup. Meanwhile, granny and her magically gnarled finger (that is almost the same circumference as the cup) has managed to somehow dig more pills out and actually get some in her mouth. She chewed them a little and then spit out "the bitter shells" as she put it. Pill fragments are now everywhere...on the bed, on the wall, on me. Lord help me, it's like pill pirrannas were here! The front of my uniform is now speckled with debris. Hmm...Despite dehydration, the vein on the left side of my neck is now distended and throbbing, and I feel what could be horns? starting to grow out of my head....Face red, I reassure granny that all wll be made right as granny's family starts demanding that it "took so long to get the pills, now we'll be here forever! We need blankets, and a phone, and food, and blah blah blah!" Also it the faint distance....I hear a voice...."Nurse! I need you to get over here and start an IV on this hyperactive 5 year old, get a stat NG in room 6, and did granny smith in room 11 get that medication yet?!?"........

[TazziRN, RN]

(i already did a in home pregnancy test why do i have to pee in a cup to have you do the same test basically and waste the insurance co money - )

Then why did you come to the ER?

(when i said i was not pregnant i meant it - one needs to have sex to get pregnant right? so if i say i have not had sex and there is no way i am pregnant why waste the money doing the test anyway. )

You have ANY idea how many Immaculate Conceptions we have seen?????

[llrn]

Loved reading all of these and can certainly relate. The last student I precepted in the ER went around with her mouth dropping open half of the time saying, "I can't believe this!!". It is easy for any who have not witnessed the daily ER riff-raff to judge us as uncaring by our comments. But consider the source.....unless you have been there, you basically do not know what you are talking about. I agree with the poster who made the comment to work in the ER for a month and then let's see what you think.

So........my advice to those who choose to berate us for venting....walk the walk before you judge us. I can be and am one of the most caring people you would ever want to know. I have cried with family members who have lost a love one....the sympathy was real......don't tell me I am cold and uncaring......I am not. But until I was subjected to the ER I was naive. It has definitely been an eye opener. I believe ER nurses need to vent and the sympathy comes to all of us at the appropriate time. We have to have a sense of humor or we will be eaten alive.

More rules for the ER:

Don't come to the ER for a yeast infection at 3am and keep telling me every 15 minutes that you have been here for 2 hours without being seen and all you need is a prescription and you will leave. I can't prescribe and the doctor is busy with emergent patients. Walmart has Monostat!

Don't bring your 9 year old with you to the ER because you need Methadone after missing your appt at the clinic because you were in jail. Unless the ER is empty (never happens), your problem is low on the list and you will be waiting. Do your child a favor and let them sleep at home.

And please, please, all of you people with multiple meds and multiple complaints, don't bring a grocery bag full of meds in and expect us to make you a list. Have one ready for us!!

Thanks for the laughs!!! ?

[twotrees2]

rosieseattle said:

I think perhaps we should also remember that if it were not for our patients, we wouldn't have a job. I also think that some of you might feel somewhat different if you ended up being the patient in the ER. Sometimes, it is only a "gut feeling" of a parent that convinces them to rush to the ER with their child. Everybody...yes everybody that checks into the emergency room has an unmet need or they wouldn't be there. It's YOUR job to suck it up and do your job without whining and judging the human being that is there for care. If you don't like it,...then YOU go somewhere else. The hospital doesn't belong to just you, it belongs to the people...the homeless, the poor...the ignorant and the drug abuser and the alcoholic...the repeat offender...whatever.

Having a list of health issues and surgeries a mile long and a med list just about as long ( that though i print them both out and forget to take them and promptly forget something in the long run ) - as a patient not a nurse - i can sympathize with a lot of these - i am the worlds worse patient admittedly and i bow in apologies to the nurses who had to deal with me over the yrs and in the future - i am glad that the nurses can make a joke about me and get over it - better than have them yelling and screaming and being mean to my face when i am really not feeling well ( even when i am on the phone trying to make sure my dh is taking care of the kids cause i hated to leave cause he was hung over but i had no choice i was in need of attention - his drunk lasted 2 weeks - i went in about 1 and half weeks after my abd pain starts when i finally could not take it anymore at a day off of his drinking to be sure the kids were ok - one may have valid reasons for waiting a week with pain as i have described - luckily the nurses knew me and my situation at home and bless them even advocated for me to have meds sent home with me and have me come back in am for the tests they had to do then - as long as i promised if meds did not stay working to9 come back - sometimes being in a small town know everyone place is a good thing lol . )

When i as a nurse am able tyo make jokes and laugh about with others what i have been through and have someone else say i know ho w ya feel i tend to get over my frustrations easier , dont feel alone and am able to deal with the next trial of idiotic stunts residents or family pulls - just my view on it here.

[twotrees2]

EDValerieRN said:

Too bad that unmet need is often a shower

I'm kidding... kind of. Like I said in the original post, I love my job and don't want to go anywhere else. I even like my job enough to come here and vent about it rather than to tell the patients my "rules."

I'm not doubting that everyone presenting has a need... I'm just thinking some people need things I can't give them.... like a good kick in the rear.

and as i posted prior to this - from the world's worst patient ( me lol) - i thank you for venting here and not blowing it in my face when i am in the er with whatever the issue may be - be it stomach flu or worse lol. i feel like i kinda have the best of both worlds here- i can sympathize with you being a nurse myself, and understand why you feel the way you do being one of those worst patients in history lol. it is obvious you do love your job and take it seriously and i am sure by your posts you aren't venting at your patients but giving them the best care you possibly can. vent all you want here in my book. hugs. ( gads i just LOVE this spell checker thing i was given here - makes a world of difference - i can even read my posts and i bet you all like it better to lol. )

[twotrees2]

Sugar9486 said:

I understand what you are saying, and if you told my post as telling you that you are a horrible person, then maybe I did not write how I meant to write. I know that there are people who are not sick in your eyes, and there are people who are not sick at all that come to the ER, but the fact is that regardless you have to treat them. I am not speaking about the nurses who treat every patient the same way... As I said before I have been to many hospitals in my area and many of the nurses are rude and nasty. I'm going into this field I know that a lot of times it's because they are over worked and under paid, but that is not the patients fault. My view is that maybe if nurses were more polite and kind to their patients maybe there would be more nurses in the field. I think that a lot of the nursing shortage is because people see how nurses act towards them, and they do not want to turn into that. The reason I am becoming a nurse is because I want to help people, I want to care for people, and I want to make a difference, I never would have become a nurse though if I had not met some of the nurses at one of the local hospitals where they strive to be polite and happy. It's a proven fact that when your nice, happy, and polite to people they get better faster, so for the people who sound angry and mean in their posts maybe you should rethink how you act.

ER nurses take a lot of crap, everyone knows this, and it takes a special person to be an ER nurse, you guys come on here and say some of the most hurtful and rude things and make me want to rethink my career choice... Think about the effect of your words to others... they do make a difference.

NurseErica- I'm glad that your one of the nice nurses out there, and I did not mean to offend you, but there are people on here that say things that should probably not be seen by everyone. When I'm a patient in the ER I try to be calm and easy going also, I know what emergency means, I've been trained to know what it means as have you. The people that come in thinking they are dying because they have a bad stomach ache haven't been trained to know what an emergency is and to them, they really do think it's an emergency. It's tough when your job has to revolve around something that can be someones opinion.

As for the fact that emergency rooms are for emergencies, this is true, I know that, but where I live at 2 in the morning when you have a severe migraine where are you suppose to go? We don't have urgent care facilities, the only option is the emergency room.

i'm sorry you feel it makes you want to rethink your career - however though you are right that these things shouldn't be seen by everyone - think of where you are - this is a nursing forum so its quit the appropriate place to have the banters. honestly try to look past the exaggerations and find a little humor - being a nurse you will need it so you don't feel like crying everytime you go to or from work. the best to you. hugs.

[flashpoint]

twotrees2 said:

the way i try to look at "jokes" such as we see here and have seen elsewhere is this - there is maybe a bit of truth - some ( or maybe a lot lol) exaggeration and a good laugh and maybe even a lesson or example to pay attention to warn you lol in it - that way i dont get offended as easily because i know that someone somewhere has had some form of the joke and i try to picture it - sometimes there is nothing funnier than real life - and if ya cant find the humor you'd only want to cry a LOT and its better to laugh. dont be nervous - one day you will make up your own joking and make many laugh ( of course lol - i do find that unless its someone in the medical field they dont always understand the joke and may be really offended or look at you like your nuts lol) - smile - its a great day:)

"Jokes???" I'm pretty willing to bet that there is a lot more serious reality in this than anything else...we couldn't make this stuff up. ?

[santhony44, MSN, RN, NP]

cotjockey said:

"Jokes???" I'm pretty willing to bet that there is a lot more serious reality in this than anything else...we couldn't make this stuff up. ?

Absolutely! To paraphrase something I read somewhere else, truth is stranger than fiction because fiction has to at least sound plausible!!!

I mean, if I made up a patient who only takes her birth control pills when her husband (a truck driver) is home because she isn't having sex when he's away, Well, now, you wouldn't believe me, would you??