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.

Specializes in ED-CEN/PACU/Flight.
Tazzi...you are so mean! :)

I'm the one that does it... :imbar

Specializes in Emergency.

I am appreciating the diluted dilaudid information and storing that one away for future use!

Thanks!

Specializes in Clinical Research, Outpt Women's Health.

Sugar,

I think people mean that when you deal with these things and more, over the years and as the nurse, who has responsibility that is different than what you have yet experienced, you may feel a little differently.

I think there other point is that this was clearly labeled as a forum to just be able to vent and get a little comic relief so that they can continue to deal with the many changellenges as a caring and compassionate nurse.

They deserve a safe place to do that and this forum was supposed to be it. You will learn that it helps to prevent burn out.

I thought your apology was gracious, and that you probably have the personality needed to becoma an excellent ER nurse if you so choose.

Just remember that you experience things differently when you really are the ER nurse. Your ER experience is great, and will help you a lot, but it is a whole new world when you become the nurse.

All the best to you.

Specializes in Corrections, neurology, dialysis.
kstockdalern:i do not know how much each pill costs and i have 500 more to give today. i know what they do, what their side effects are, and why you need them. end of story.

why are you a nurse then? i know that in my nursing program we have to know what side effects are and why the person needs them, if we do not then a paper with this information on it is given to the patient.

um, if i'm reading this correctly she did say she knows what they do, the side effects and why they need them. what she doesn't know is how much they cost. i just finished pharmacology and i don't recall there being a chapter about how much drugs cost.

If you are well enough to go out and smoke, then you are well enough to go home NOW.

If you call the ER to ask what the wait time is then you are not that sick.

The more you stand in the door way and stare us down, the longer you will wait.

Everytime you ask the traige nurse "how much longer" you will be placed at the bottom of the list to go back. In other words...don't tick off the triage nurse...and even if you do talk to "my supervisor" they will ALWAYS back me up.

You will NOT starve to death if you miss a meal.

Specializes in Corrections, neurology, dialysis.

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.

Yes, I couldn't help noticing that the only people who protest these posts are non-nurses.

They keep saying "walk a mile in the patient's shoes." I wish more people would walk a mile in the nurses' shoes and see how it feels to be unappreciated and abused by the people you are trying to help. It would be easier to overlook if it was just one patient now and then. Then it might be easy to look at the patient and say "well, maybe he's having a bad day" or "well, maybe her parents didn't raise her right." But when it's multiple patients all day every day, it gets old.

Specializes in ED-CEN/PACU/Flight.
I am appreciating the diluted dilaudid information and storing that one away for future use!

Thanks!

Not a problem! Anything to help fight the war on frequent fliers that do not have an actual urgent or emergent problem! Now if only we can get the free gift program started. You know the one I speak of - a free toaster with every 10th visit...

:lol2:

Nah, maybe we could just put the empty medication vial on a keychain and hand it to them?

If you call the ER to ask what the wait time is then you are not that sick.

Caller #1: Are you guys really busy?

Me: Yes, we are.

Caller #2: Can you tell me how many people you have right now?

Me (counting staff bodies as well): A lot.

Caller #3: Is the wait really long if I come in right now?

Me: Yes. (I don't add, "If you're coming in for a hangnail I will make you sit out there as long as I can.")

Love this thread!

I don't work ER, I work cardiac, but I totally feel for you folks.

My additions:

If you berate the nurses, scream about needlesticks from phlebotomy, etc. you can bet that your IV will need changing and it will be a 16 or 18.

If you go to administration because it took the nurse 10 minutes to get you your darvocet, and you think it is because you are a minority, you can bet that we won't kiss your @$$ the rest of your stay and wait on you hand and foot.

If you tell us that you have sued this hospital once before, and you think it's a bad hospital, you can bet that will we chart every word you say verbatim.

If you have horrible chest pain, but "nitro doesn't ever work", you can bet you get three nitros every single time, and EKG, and call the Dr. before you get any morphine. Also, in this case we have very little sympathy for nitro headaches and tylenol is the remedy, not demerol.

If you point out the vein that you "normally use" and swear its a good one, I refuse to use it, just on principal.

If you threaten repeatedly to go AMA, and you are waiting for open heart surgery, I will soon get tired of trying to convince you to stay. Again, AMA paperwork is much simpler.

Just because the ER asked you a bunch of questions, this does not mean that I can "call the ER nurse" and get all the answers. I WILL ask them to you again, and I don't have time to listen to your griping.

Just because you demand a private room does not mean that we have one. Just because you SEE a private room open, does not mean that its not assigned or that I don't need it for someone really sick (see post one)

Just because your roommate is annoying doesn't mean I don't think you are too.

If you can't remember your own meds or take them correctly and you are an adult person who is not senile - why do you think that I am psychic and know what your "water pill" and your "blood thinner" are and the exact dose?

If I ask the question "so, who wipes you at home?" you know I am getting ticked off and you better do something for yourself if you intend on going home tomorrow.

If you want to complain because it took 5 sticks for us to get an IV in you - then why did you pull it out?

If your family calls the floor every 5 minutes checking on you, I won't have time to take care of you properly.

If you want me to mediate between you and your half-sister's husband, etc. and not allow them in the room - I am not Judge Judy. Work out your own problems.

If your refuse meds and procedures but still want to get well, then get out.

No, you cannot plug in your cell-phone charger right in front of the "turn your cell phones off, please" sign.

If your chest pain is a 10 and you are flipping channels and eating a big mac your family brought in - I am much less sympathetic.

If your senile mother in law is in the hospital and you are trying to get her to sign and make you power of attorney, I will not witness it.

I do not know how much each pill costs, and I have 500 more to give today. I know what they do, what their side effects are, and why you need them. End of story.

No, I will not give you a portable oxygen tank so you can go out and smoke.

I know all of this is not stuff anyone is taught in nursing school, and I truly do care about most patients. It is those few patients that you always remember though.

Good luck, everyone!

Do you work in Michigan? Just wondering.

I am not a nurse and I agree. I spent many a day in the ED (my doctors wouldn't "fix" my gallbladder) and I saw many many stupid things happen because people are impatient.

Specializes in Med/Surg.

I've been reading these occasionally, and I really, really feel your pain when it comes to people who abuse the ER.

In my adult life, I've been an ER patient twice. 12 years ago, postpartum, with a hemoglobin of 5.8, and.... yesterday, with a ridiculous laceration in the palm of my hand. aaauuuggghhh I hated going in there! came away with sutures and a tetorifice shot.

everybody was great... doc was voicing some of the same complaints you all do, but didn't seem to be directing them at me, just making conversation.

Specializes in ED/Trauma.

Hilarious forum,and oh so true.My ER coworkers and I can relate to everything.

The sickest people make the least amount of noise...

Student nurses who call us mean don't even know what they don't know yet!!. Talk to me in 5 yrs.

My mom used to be a nurse 50 yrs ago and when patients pissed them off they'd blunt the needle before an IM injection..

If you are going to stick a foreign object up your butt,attach a damn rope to it so you can extract it.. Pt 2 weeks ago had his "girlfriend" insert a toilet brush up his butt while having sex!.{Brush end out,picture that!!}Of course ended up in surgery.

If you are a gang member and get shot[non lethal],don't cry for your mom,it makes you look like a big -ussy.Not so tough now,huh..

Your fingers will never move faster than a lawnmower blade.

Medicaid is not 'your' insurance. We're the suckers paying for your 9 kids.

If you can say." I'm having a seizure" You're not!!

If you pretend to be passed out,but can still flutter your eyelashes,and fail the arm drop test..I have a sternal rub that will wake the dead and an ammonia capsule with your name all over it..

People ALWAYS get a ride home.How many bones have you seen outside the ER???..

And the party never ends......ED nurses rock....