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.

[Gompers, BSN, RN]

You have now attracted the ire of every ER/ICU nurse in existence. "The opposite of 'loud'" would have given the same information!!!!

My family isn't even allowed to say that word to me on the phone when they call me at work!

Well I don't say the word AT work! I'm not crazy!

This is NOT work, I figured it would be safe. However, if someone on the board has a really really really busy night in the ER becasue of it, they are welcome to throw things at me here.

[twotrees2]

"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"

My response..................if more er patients were more polite and kind to their NURSES, maybe there would be more nurses in the field. I think that a lot of the nursing shortage is because NURSES see how patients act towards them...............:smiley_ab

:balloons: sorry just trying to see where you get all these cute little icons you have all the time- seeing if this works lol - :chuckle

If you live in an area with no urgent care centers where are the people who don't have a PCP or don't have insurance suppose to go. People go to the ER because they need help, not because they want to make the nurses mad because that nurse doesn't think that they are ill enough to be in the ER. I totally argree with rosieseattle. The ER is a place for people from all walks of life. Just because the nurses feel that the nonemergent case should wait does not mean that all people agree with them. If we lived in a society where health care was free and no one needed to pay for it, then yes there would be less people in the ER day in and day out, but until that happens (Which doesn't look like it's going to happen any time soon) we're just going to have to deal with people coming to the ER because the person doesn't have insurance or doesn't have a PCP.

or folks who cant get to see their PCP

one day i had my son with a terrible earache getting worse- unable to get into his pediatrician or any other doc except the PA - ( whom by the way diagnosed me with pneumonia sent me home on antibiotics and a week later i awoke to find i had had a heart attack - i should have sued but did not - they KNEW the x rays said no pneumonia and my DH had told them i was totally out of it he could not wake me instead of telling him to get me to er they said ok let us know how she is doing in a few days..... ummm and why do phone assistants call and not docs when the assistant isn't even a nurse??)

anyhow, no way I'm taking my kid or anyone i know to that guy again and so i went to the er - here its triage out as emergent care or a walk in clinic for those who have situations but yes we should be more patient.

And yet many of those coming through that door presenting with the most benign issu

rked as a nurse for 13 years, and had to get healthcare as an uninsured twenty something.

i do have to say - our area has no docs that will take payments - no free clinics - ( nearest one is a 45 min drive and you still may not qualify for free if you dont have kids or you dont have a job - hows that for a ticket - to get free health care you have to have low income but yet someone with no income is excluded

i have yet to figure this out and watched my brother eat so much ibuprofen, to kill the pain he was in with his tooth infection until i yanked the tooth and made him drink colloidal silver for a month ,that i cant believe his liver isn't shot lol ) and many dont have transportation) and having Been at all 3 spectrums at one time or another - uninsured - "in the system" and insured through jobs - there IS a difference here in how one is treated if you dont have regular insurance around these areas anyhow - sad bt true

and I've seen it from both ends as the nurse ( seen others doing it - not a lot but enough ) and as a patient ( feeling it when " i was in the system or had no insurance" - not many options then but to present at er for eval cause they cant turn you away if a doc refuses you.

i am glad i dont live in an area where we have to see the drug addicts ( though we have our blacklist it is relatively small of say maybe 4 people lol) and homeless - i am sure it is quite frustrating.

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!

.

yep - if i talk to the adult kids- 20 and 23- they tend to think oh that gross mom lol - and hubby well - he isn't into any of it so no help there - the rest grandfolks and the like are either to busy or dont wanna hear it so here i am lool. have had fun reading the posts - oh so true and blue in here hahaha.

[TazziRN, RN]

if someone on the board has a really really really busy night in the ER becasue of it, they are welcome to throw things at me here.

:roll :roll :roll

[LeahJet, ASN, RN]

I think it would be a good thing if MORE non-nursing oersonnel read this thread. It's called reality orientation.

Thank you!

I was thinking this very same thought a few days ago. I hope the general public reads this. Heaven knows, we can't educate the public at work....we may hurt someone's feelings and get a bad survey!

The "non-nurses" and "pre-nurses" should take note that every ER nurse (with more than a year experience) is agreeing and contributing to everything said. That should give a really strong clue.

[lpnstudentin2010, LPN]

This site may be read by non-nurses, but it is a site FOR nurses.

The non-nursing posters who slapped our wrists were non-RNs, not non-nursing people......students, etc.

"Big T"?

Non nurses (myself included) should be respectful of what you all go through. Although i made a comment earlier that may have been seeming to flame it wasnt. If someone is going to read this site that is not a nurse they should realize that nurses need to vent. just because a nurse says something here does not mean that they say it at work. in fact if they say it here they probably do not say it at work because they got it out of there system in a safe envirnment where people are more understanding.

[Medic/Nurse, BSN, RN]

I'll add a few---

* DO NOT bring an ENTOURAGE with you. Unless you are on a tour bus that has diverted to the ED because YOU were having CHEST PAIN, even then...

* DO NOT ask me if you can use your cell phone. You saw the sign - but, how could it possibly apply to you?! I'm can't give you "special" permission

* DO NOT threaten me.

* DO NOT invade my space in a hostile manner. (Especially important if you have just threatened me).

~Both of these will result in immediate corrective action, and maybe the police~

* If you hit me, bite me or otherwise assault me (and you know that it is wrong) I will assure you a poor legal outcome. I will have you arrested, prosecuted - I don't care if my employer thinks it may be "bad press" - I did not waive any of my rights when I put on my uniform. If you injure me, I can and will sue you for pain/suffering/punitive damages if at all possible (my workers comp may pay my medical bills, but you will pay the other damages).

* I know that you have "terrible veins" if you weigh 300#, smoke 2 packs a day with CAD, diabetes & COPD. No, I cannot use a "butterfly" - you need IV access. If is usually more difficult since you choose to abuse yourself.

* If you ask me if I am "any good" at IV's, because the last time "they had to call the IV nurse" - I assure you I DO NOT and WILL NOT try to torture you. I just don't have the time or inclination. I just need to get things rolling here! (I've lost count after the first 15 Thousand IV's, but ...)

* DO NOT let your kiddies play on the floor, with the trash or push the call light for their entertainment. The first two are just thoughtless and neglectful parenting. The last one just makes me ANNOYED!

* If you show up via ambulance and before I can even start to determine what life threatening situation brings you in, you demand "some pink lemonade with just a little ice and a box lunch for later" ~ I am confident that you don't have an emergency (or 10/10 pain)

* DO NOT WHIP OUT YOUR CAMERA PHONE AND START TAKING PICTURES. I do not care why you think it is necessary. I will call for security officers and an administrative director to come and discuss this matter with you.

* If you insist on holding my arm ("because I've seen how some nurses just gouge around and I'm going to MAKE SURE that you don't) while I'm starting an IV on your ____ . It can impact my otherwise 98% success rate.

* No, I don't want to go out with you. Yes, I know I'm not wearing a ring - too much funk in here for rings. The ED is not a bar. And my husband gets mad if I date.

* Tip for MD's: If you have been giving your patients lots of narcotics for pain relief and have not addressed the need for a plan "of good bowel health" you are near guilty of MALPRACTICE. To further send them to the ER for a $6,000.00 soap suds enema (we have to make sure that abdominal pain/pressue/fullness is just a poo issue) you should be charged as a CRIMINAL ($). Maybe you should have them come to the office for that problem ...I'm willing to bet that a few in office SSE will result in your patients getting a good plan for regularity (along with those 120 Lortab)

* Sick kids are not "cute".

* I know that you are aware that your SMOKING can make your kid's asthma worse. I know that because - after we intubated your child for respiratory failure and you came back into the room you look at me and say, "Will the smoke on my clothes bother him now?" NO, not now it wont.

* Of course you NEVER smoke in front of the kiddie - the fact that the baby reeks of marlboro's is just .... sure, of course.

[santhony44, MSN, RN, NP]

DO NOT let your kiddies play on the floor, with the trash or push the call light for their entertainment. The first two are just thoughtless and neglectful parenting. The last one just makes me ANNOYED!

Especially don't let your kid play with the trash in the red trash can. That's where the really nasty stuff gets tossed (like used vagnial speculums). That "biohazard" symbol on that can isn't just there for decoration.

• I know that you are aware that your SMOKING can make your kid's asthma worse. I know that because - after we intubated your child for respiratory failure and you came back into the room you look at me and say, "Will the smoke on my clothes bother him now?" NO, not now it wont.

You may not smoke in the house with the kid, but I'll bet you breathe in there. If I know you're a smoker before I get completely through the door of the exam room, I'm really not psychic and you can bet that your kid is breathing in some of what you breathe out.

[Altra, BSN, RN]

Rule #317 ... about the comment, "But I'm NEVER sick, so there must be something really wrong!"

You never get sick? Really? Wonderful. I mean that sincerely, as a healthy immune system means that you've probably got other things going for you like good nutrition, etc.

However, on this particular day, it seems that you did not have all 6 winning numbers in the Stomach Virus Sweepstakes. It does not up the acuity or urgency of your vomiting x 1 complaint. Have a seat, and stop drinking that soda.

[BabyRN2Be]

I remember the ONE time I said the "Q" word, in L&D triage no less. The thing is, I should have known better!!

The moment the word escaped my lips, I was backpeddling, big time. Before the triage nurse could even say, "DON'T EVER say that word!" I was saying, "Well, I meant that as in.. ummm.. there's no brass band going through here at the moment!! The decibel level is low in here compared to the expressway outside!! Please forgive me!!"

Fortunately there were no ramifications due to my slip, and ever since then I've been REALLY careful about saying that word in any fashion at the hospital. :)

[mamao4]

I am a nursing student (striving to be an ED nurse...I know, I'm a glutton for punishment!) and I also work for an ambulance service. I have enjoyed reading all of these "rules"! Speaking from the student side of this matter, I appreciate the humor in this and take it at face value. It makes me admire the ED nurses even more. Speaking from the "real world"/EMT side of this, I would hate to tell Sugar and that seattlerosie person some of the things that the EMT's and Paramedics say about some of the people that we bring in! If you don't have a sense of humor in this line of work, you might as well hang it up! You will never make it through. It takes a special type of person to be a nurse and it's people like Sugar that ruins it for the rest. You really do need to lighten up and not take things so personally. Are you also the one in your class that answers ALL of the instructor's questions because you want to show off your book knowledge? There's one in every class. I will have to agree with the RN's that have responded (the ones that already have their license). You need to actually BE a nurse in the ED and be working on your own (not with a preceptor or in an orientation). Every party needs a pooper....

[andhow5, BSN, RN]

I just want to clarify - for the person that thought most of these were "jokes" or exaggerations"...

They are not. Sad to say that truth is stranger than fiction! We couldn't even begin to make up stories that are wilder than what we actually see.

The rules are being stated for a good reason - WE NEED THEM! People just don't think anymore, there is such an overwhelming sense of entitlement, coupled with a drive-through mentality.

I don't care if everyone that comes through the doors thinks their problem is an emergency. I *will* see everyone that wants to be seen; however, it will be on MY terms.

The amount of attention you get from your nurse is based on your REAL (not perceived) needs. Every patient will get respect from their nurse as long as it is given.

We all know that even though the patient is a frequent flyer, they might have a "real" problem the next time they come through the door, but we can smell the lies a mile off. It will take us less than 10 seconds to see through the BS and determine what the real issue is. We can spot true problems within 15 seconds or less and start the patient on the appropriate pathway while juggling their needs with the rest of the chaos in the department.

Now if I sound "mean" or "cold hearted" because I refuse to come in the room and pull the blankets up 2 inches (when the blanket is in reach of both your perfectly good arms), or move your left foot over 1 inch (when it is not injured and your condition does not prevent you from moving your own leg), SO BE IT.

I'd rather be perceived as mean and cold hearted by ignoring or refusing those demands (note that I did not say requests) and spending my time caring for the grandma having a heart attack, grandpa having a stroke, teen-aged near-drowning victim, or the young father that is a MVC trauma that had a leg amputated, et cetera...

The sniffles, hangnails, tooth pains, ear pains, or ANYTHING that has been going on longer than 4 days - will have to wait. You WILL be seen, but you WILL have to wait.

There are reasons we treat some people before others. It's called TRIAGE. You will be sorted into an assigned category, and certain categories come first.

Deal with it.

[twotrees2]

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!

yes - i to am sorry for anyone's mistreatment by any nurse - i live by the "rule" i treat my residents like id want to be treated if i were them ( and i get hit kicked bit - spit at and abused verbally every day i work - i work with alzheimer's residents -there is rarely a day i dont get bruised , heart broke or soaked lol ) however as a patient if my nurse is good to me i know she may be talking behind my back but that's ok - its her opinion and shes entitled as long as she isn't acting on them. i am hopeful the majority of nurses are kind caring and compassionate and i am sure places like this and our coworkers are what keep us sane - as many have said better to laugh then cry.