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.

A few more for the laymen.

:idea: please when you come to my triage desk and are nauseous please let me know immediately and not vomit all over my desk and floor (happened tonight with an adult no less)

:idea: please, when we ask you why you are here, it is not important what happened to you ten years ago. We just want the facts and why you are here today at 0400.

:idea: please when you are asked a question, ANSWER! we can't help you if you don't tell us what is wrong. moaning when asked a question is not helpfull (remember that is the walkin pt not the comatose ambulance one)

:idea: if at all humanly possible, if you do not speak english, bring someone who does, at least until we can get an interpreter.

can you tell I just finished 11 hours in triage ahhhhhhhhhhhhhh: :uhoh3:

Specializes in ER; Med/Surg/Oncology.
For the few people that have come into this discussion and insinuated that we are AWFUL people who shouldn't be allowed to live anymore.....WE ARE VENTING!! No, we do not say these things to our patients, and 99 times out of 100, I treat everyone the same. No, I won't be in the stable abd pain pt's room as much as the unstable GI bleed with no blood pressure, but all of my patient's immediate medical needs are met.

Until you train your ass off, learn how to care for 1000 different kinds of illnesses, and work in the ER for a time, you cannot begin to comprehend the crap we deal with. It is a chaotic atmosphere, and we must prioritize our time and energy. Wouldn't you rather I spend my energy on the sick sick (see post 1) patient rather than the non-sick abd pn patient? And yes, a lot of us CAN tell pretty quickly who is sick and who isn't.

I am not saying that the ER is "better" than anywhere else. Although to me, it is.....I could never work anywhere else in the hospital. It is impossible to describe what it is like to do compressions until you're sweaty and your arms are ready to fall off, call that code, then walk into another patient's room (not sick pt) and hear a bunch of complaints about how mother is cold/hungry/hasn't been to CT yet. The thing is, most people don't stop to think about the other things that may be going on....maybe mother hasn't been to CT yet because we were holding it for the 5 level 1 traumas that came in at the same time (happened to me last weekend).

Emergency rooms are for emergencies. Urgent cares are for urgent needs. The doctor's office is the place for that annoying arm pain that has been going on for 2 months. I wish people could walk 100 feet (it wouldn't even take a mile) in my shoes before calling me a "bad nurse". And yes, I have been on the opposite end (the pt) and I make it a point to be as calm and easy going as possible. Because, as long as I'm still breathing, there are people that are sicker than me.

It does get rather irritating to see the same people stroll through the door that come for non emergent problems. Yesterday I had 2 separate cases of supposed seizures that amazingly responded to ammonia inhalants. A mother of one was so good (child was in his 30's), that she predicted the exact moment he was going to have a seizure in front of us. Give me a break. I too love my job, but please, go to your family Dr. for the bs and leave us to do the serious er patients.

Specializes in Med/Surg, Hospice.
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.

I almost spit my Coke on my monitor! LOL!!!

Specializes in Flight, ER, Transport, ICU/Critical Care.

Some "seizures" are actually = AMMONIA deficiencies in disguise. BE AWARE! or BEWARE - I forget, but... I do love the simple effective treatments.

:)

Ammonia------the Wonder Drug!!

Specializes in ED-CEN/PACU/Flight.
I like you!

LOL! I get my point across very well, can you tell? Heheheee! And I get a kick out of your posts too!

I love the pt's that are allergic to every pain reliever except Dilaudid, LOL! If they are being a really bad @$$ (rude, aggressive, threatening, inappropriate, et cetera), then I get really b*tchy and for their *safety*, dilute that Dilaudid in a 100cc mini-bag of NS and infuse over 10-15 minutes on an IV pump (not a syringe pump because it's too easy for them to bypass) after setting the lock out mechanism (the docs get a real kick out of this one and always approve it)...

That way they have still receive their ordered medicine and we have made reasonable efforts to control their pain!

Of course, this is for the patient that is not a *real* patient - reserved only for the users/abusers/frequent flyers.

LOL...we have a seizure patient who looks around to make sure no one is looking, lays down on the floor very carefully, screams, and starts to twitch. She then spits, stops to wet her pants, screams, and starts to twitch again. She'll hold her arm up for you to put a B/P cuff on and stops twitching when you put on the tourniquet to start the IV...EMS did the I/O bulls-eye thing to the sternum once when they couldn't get a peripheral line (What is that thing called? Am drawing a total blank here!) We took her to Denver once and everytime there was static on the radio, she twitched for 3 seconds and went back to a normal LOC.

Sometimes funny, sometimes frustrating...but, she makes excellent kolaches and brings me a batch every year at Christmas because she says I am always nice to her...she even sent me a sympathy card when my sister died. I always want to tell her if she wants to see me she can call and we could do lunch!

:)

Specializes in NICU, Psych, Education.
EMS did the I/O bulls-eye thing to the sternum once when they couldn't get a peripheral line (What is that thing called? Am drawing a total blank here!)

I think you're referring to the FAST1 Adult Intraosseous Infusion System. I bet that got her attention! (And I tell you, I've never heard of a frequent flyer who makes good kolaches, so consider yourselves fortunate.)

I think you're referring to the FAST1 Adult Intraosseous Infusion System. I bet that got her attention! (And I tell you, I've never heard of a frequent flyer who makes good kolaches, so consider yourselves fortunate.)

Yep...that sounds right. I've used it once...just can't remember what the thing is called! I just finished PALS today and my brain is all used up...

I get really b*tchy and for their *safety*, dilute that Dilaudid in a 100cc mini-bag of NS and infuse over 10-15 minutes on an IV pump (not a syringe pump because it's too easy for them to bypass) after setting the lock out mechanism (the docs get a real kick out of this one and always approve it)...

That way they have still receive their ordered medicine and we have made reasonable efforts to control their pain!

Of course, this is for the patient that is not a *real* patient - reserved only for the users/abusers/frequent flyers.

Ohhhh......I have GOT to remember that one!!!!!:lol2:

Tazzi...you are so mean! :)

Specializes in Emergency Nursing.
Some of these I just can't laugh about. I think few of your statements are plain mean.

Come back and review your statements after you've been at this for a few years. A nursing student is NOT a nurse, (sorry).