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]

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.

yes - i too have fibromyalgia on top of many many other things wrong - i would never have guessed it could hurt so bad - never ever in my wildest dreams - it taught me a valuable but painful lesson on pain and being compassionate about it - but i do still understand the ones who come in and really do just want the drugs or whatever . though i have had to cut back on work and cant help the aides as much as id like ( with heavy lifts as much even though i still do and suffer the next few days lol) i pray it never gets to the point i have to quite as i do love my job - my heart goes out to those who have had it effect them and had to get out of what they loved.

[twotrees2]

~sigh~

I hold people's hand all the time...yes, it's usually to keep them from clawing at the NG tube that is passing through their esophagus.

I wipe tears and blood off of faces all the time.

Hugs? Does holding a kid down for an IM count?

I've been known to have a couple of teary eyed moments in the ER.

But..."just be there"?....nope....I could never get away with that!

i could get away with it ( i dont work er -) but who has the time? not much often i get the time to actually do these - i miss em too;.

[TazziRN, 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.

I like you!

[twotrees2]

(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?????

LOL sorry - guess i did not make it clear - i was not in the er - i was having a colonoscopy done - just making a generalized statement of stuff they want done that i feel is ridiculous lol. sorry. as for immaculate conception - well LOL - dont think id fit the good lord's job description to well HAHAHA

[twotrees2]

"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. :)

the best stand up comedians I've listened to always start off with the truth and twist it to humour - i love life- without all our mishaps and troubles what really would we have to laugh at lol.

[twotrees2]

Thank you for understanding my side of the story, thats I wanted... I think I made some people kind of angry, but I didn't mean to... I understand people need to vent, but some of the things just went too far, thats all I had to say

i do understand your side of the story - and your right and i am sure most here would agree with you that out in the normal world with laymen and patients we wouldn't say these things - but please try to understand their side also - they are not trying to be mean - a lot of these are real life things - they happen - and here in where there are nurses that should understand they should feel safe to post them. if you find them offensive - weather you have worked with patients or not there is always a way to stop listening and that is to stop reading. name calling like saying they dont care or are mean or any other words you may habve used made them feel a need to defend their integrity - none should need to do that here when saying things in jest. hang in there and like i said - always look for the funny side of even the worst situations or you may find yourself quitting nursing or being crying way more than you need to. hugs to you and may the good lord bless your path.

[twotrees2]

Big T...While I agree this thread is therapeutic and not mean spirited in any way, we have already had non-nursing posters admonishing our therapy. This is not a secure site and anyone from the public may read this and like others misinterpret the content. I'm just pointing this out because it isn't excactly safe... from public scrutiny anyways. That being said, I'm all for punitive wait times , so don't tick me off when I'm assigned triage !

though we are not secure- if non medical personnel are here THEY are subjecting themselves to the arena - it is clearly posted as a medical site - it is not us shoving it down their throats as like if we were in the er and yelling it at them.

[twotrees2]

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? :

i say lets give sugar and others who dont know the chance before we say they are the ones who ruin it for all - yes - there are some like that - and i find they are ones who have been in nursing a looonhg time and never found the humour but only found bitterness - i am going to give the benefit of the doubt to those here that are learning that when they DO get in the real world of nursing they will think back on this thread and perhaps they will then see the humor and the importance of the letting off steam. hugs sugar and all........ hang in there and keep these in your mind and keep an open mind to them so you dont get bitter and negative as you get further in your carer

[Jennifer, RN]

1. If you are hyperglycemic and symptomatic, no, you can not have something to eat or drink. You will throw up and possibly seize.

2. If you do not take your meds, you will feel bad.

3. We are not a hotel. I am not a maid. If you took care of yourself before you came in to the ER, you will be expected to take care of yourself here too.

4. I do not want to hug you or get any closer than I have to to you.

5. If you are really sick, please don't feel the need to apologize. I don't mind taking care of you. THAT is what my job is all about.

6. If you do not want an iv or blood drawn, do not come to the ER.

7. If your child is crying, please comfort him/her. And do NOT forget bottles, diapers, pacifiers. We do not have these items. You are the parent, please continue to suppy your child with love, comfort and nutrition for the next few hours as well. Do you go to other places without these items?

8. Try not to complain about how long it has been since you have eaten or drank anything. Chances are, I have been longer without food and water than you (or toilet for that matter). In fact, that barium is looking mighty tasty.

9. You will be seen by an ER doctor, not your personal physician. Otherwise, it would be called a doctors OFFICE visit. The ER doctor is in charge now and will be deciding your plan of care.

10. You are now in an ER. Be prepared for blunt answers to your questions. If you do drugs, we will tell you to stop doing drugs. If you are an alcoholic, we will tell you to stop drinking. If you have high blood pressure or diabetes, we will tell you to keep taking your meds, or you will eventually slowly kill yourself. If you do not want this advice, DO NOT come to the ER. We do not sugar coat advice or teaching.

11. We do not have free meds. Go to the health dept. If you do not have a way home, you will be walking home or sitting in the lobby after discharge. We do not chauffer people home.

[LoriAlabamaRN]

(This one from a friend of mine who works in the ER)

If the nurse is skeptical of your allergy to everything except dilaudid, and therefore has mixed your dilauded with a lot of saline and is pushing it into your vein slowly via the highest port on your IV line, do NOT rip the syringe out of her hand and jam the medicine in as fast as it will go. She will pull out your IV and the meds will simply run out onto the floor. And you will not get more.

[gwenith, BSN, RN]

A bit on the other side

Please do NOT ignore that 10/10 chest pain - we actually DO WANT to see you - soonest!!

[TaraER-RN]

I wanted to add this one...I kinda saw it in other notes, but:

No, I will not push this "narc of choice" in the closest port, as fast as I can, since that "is the only way that works for you." It is my license and I will push at the rate that is deemed by all the medical books. I am not giving it to you for the rush you will get with a fast push, I am giving it to you for your pain, and whether it is pushed fast or slow, you will get the same drug amount, and the fact that I need to give it safely is what really matters!