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.

The two posts about transgender individuals have made me feel very uncomfortable. Many trans people never have surgery and yes, their genitals will not match their gender expression. Please be sensitive. There have been cases of trans people dying because medical personnel were so focused on determining their sex, that their medical condition wasn't assessed or treated until it was too late. Trans people live in fear that they will one day be injured or fall unconscious and end up in the ED and have people gossiping about them and providing poor care (and yes, bad care is the norm). It is not common and as such, it may not be possible to not be curious, but please be as respectful as you can.

Many years ago a CPR in progress came in wearing only undies. Because of the hairstyle, makeup, conflicting physical atttributes, etc., we kept staring at the pt and asking each other, "Is it male or female?" Nobody was sure until we cut the undies off! Pt was male.
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Specializes in ER.

Alcon,

As a new grad RNIP working in the ED all I can say is that this stuff is priceless! It's like you guy's are following me around with a hidden camera on any given day. The NCLEX results wait continues, i'll return to my hole now!

cheers,

Mike

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The two posts about transgender individuals have made me feel very uncomfortable. Many trans people never have surgery and yes, their genitals will not match their gender expression. Please be sensitive. There have been cases of trans people dying because medical personnel were so focused on determining their sex, that their medical condition wasn't assessed or treated until it was too late. Trans people live in fear that they will one day be injured or fall unconscious and end up in the ED and have people gossiping about them and providing poor care (and yes, bad care is the norm). It is not common and as such, it may not be possible to not be curious, but please be as respectful as you can.

Okay, then I should add to my post: we kept staring at the pt while we were working on him/her. I never intended any disrespect and I don't think I showed any. I related an experience.

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Specializes in ER, ICU, Infusion, peds, informatics.
okay, then i should add to my post: we kept staring at the pt while we were working on him/her. i never intended any disrespect and i don't think i showed any. i related an experience.

and really, you can't get them registered without filling in the blank about "sex." (at least in our computer system; it is a "mandatory" field.) and there is so much you can't do (labs, xrays) unless the patient is entered into the computer. and "not sure" isn't an option!

i'd be very surpised if "bad care" really is the norm for transgender persons. even people who arn't "transgender" can be difficult to pinpoint their sex until you go to put the foley in. think of the very obese men that have breasts, and the boy-frame women that don't. we tend to "guess," and move on. if we are wrong, registration can fix it later.

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i'm not saying don't register them. i'm saying treat transgendered patients with respect. don't gawk, scream, or disclose their birth sex to those who don't need to know. i definitely agree that sex and gender can be difficult to determine sometimes. but when you are taking care of a man with a lady parts, who introduces himself as jack, who has had his breasts removed and has facial hair, it doesn't take much to call him by the appropriate pronoun. (a common complaint of trans people is to be persistently called by the wrong pronouns after they have informed the staff of the appropriate pronoun to use)

while the experience of care for trans people as a whole can be difficult to study, all the research that has been done has shown that it is appalling. every trans person i know has a horror study of encounters with the medical profession. here are a couple good articles if you are interested:

shaffer, n., malone, r. e. & hackenschmidt, a. (2005). transgender patients: implications for emergency department policy and practice. journal of emergency nursing, 31(4), 405-407.

feinberg, l. (2001). trans health crisis: for us it's life or death. american journal of public health, 91(6), 897-900.

this last one is specific to boston, but hey:

fallas, g., landeres, s., lawrence, s., & sperber, j. (2000). glbt health access project: access to health care for transgendered persons in greater boston. .jsi research and training institute. retrieved december 3, 2005, from http://www.glbthealth.org/documents/transaccessstudy.pdf

check it out if you're interested.

and really, you can't get them registered without filling in the blank about "sex." (at least in our computer system; it is a "mandatory" field.) and there is so much you can't do (labs, xrays) unless the patient is entered into the computer. and "not sure" isn't an option!

i'd be very surpised if "bad care" really is the norm for transgender persons. even people who arn't "transgender" can be difficult to pinpoint their sex until you go to put the foley in. think of the very obese men that have breasts, and the boy-frame women that don't. we tend to "guess," and move on. if we are wrong, registration can fix it later.

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Specializes in 0 - hopefully peds someday.

I'll second that. I have several piercings and tattoos but crumble anytime a syringe or IV comes at me. There is no comparison between medical procedure needles and piercing/tattoo needles for many reasons. I really wish that people would stop assuming that they are all the same - they're not!

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Specializes in 0 - hopefully peds someday.
K, as a pierced and inked nurse I take issue with that. I've had IVs started a few time, and each and every time they were worse than the things I've had done in the local tattoo parlor. :uhoh3:

This is the post I was agreeing with - just did it wrong.... I must be tired tonight.... oh well

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ooooh, i have a problem with this one. i tell my pts that they have a right to request this. i warn them that not all nurses will do it, but the pt has the right to ask. this does not mean they are not very sick, it just means they don't like pain. iv sticks are not "little".

i had a nurse sort of push the numbing shot on me at a minor surgery center once, despite me telling her to just go ahead and stick me once and get it over with. 'i don't mind, really...' it burned (because they didn't buffer their lidocaine with bicarb) and then, i guess she didn't wait long enough, because i felt the iv, too. ouch! two sticks instead of just one. i'll never allow it again.

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Specializes in Emergency Room.

Had a woman ask me if we numbed before IV (she came in for leg swelling w redness, hx PE...what did she THINK we would do?) When I told her that we didn't, except for in kids, on non-busy nights, when we actually have enough rooms that waiting an hour for an IV stick is remotely acceptable, she wigged out on me. Then I get the classic response: "Well, you'd better get somebody good because I only allow one stick, and THEY HAD TO CALL ANESTHESIA LAST TIME" In the 3 years I have worked there full time, I have never needed to call anesthesia on anyone, nor have I heard of them actually doing it for a hard stick. People with veins that crappy that need an IV that bad get CENTRAL LINES people.

As a side note, I don't care if someone wants to say "I don't have the best veins, and I'd really appreciate it if you could put your best person on it." in a nice tone of voice. But the whole ONE STICK AND GET OUT thing just ticks me off.

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Specializes in Telemetry, CCU, ED.
- Don't dump water down the front of your shirt and tell me you are diaphoretic. People don't sweat like that, genius.

- Dont check in to triage and insist on waiting in the waiting room even though there is an open bed.

- If you paint your toenails in triage, you are not sick.

-You can not request to see a certain doctor. You get whichever doctor is available. We will not call an ER doctor in to work because you are there. If you want the same doctor every time, get a PCP.

-Don't pick up a piece of gravel out of the parking lot, then later put it in your urine specimen cup and tell me that you've "Just passed that kidney stone" that you're here seeking pain meds for because you've had every non vital organ in your abdomen removed already.....(True story)

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Specializes in Med/Surg, Peds, ICU.

If you come in for "Chest Pain 10/10" please do not tell me you are going to go smoke, i will only tell you no...and then if i see you go outside I am telling the doctor, and he can send you home!

Please dont keep asking me over and over if you are going to be getting a private room like "you requested" after you leave the ER... you and everyone else has requested the same thing..so unless you have some infectious disease, alot of money, or transplant...you aren't getting one!

If your child has been really sick and in pain, I give pain meds...they finally fall asleep after screaming for 2 hours...please do not wait till they start snoring and wake them up again...it only makes everything worse.

If I give you an IV, you go outside and "shoot up"...i can tell if you did when you come back in...by looking right into your vein! we will send you home! (yes this really happened)

If you threaten me at all, your butt is going to the house!

If you ask me over and over again when you are going upstairs to get a room...i am only going to tell you the same thing. You and 23 other boarders are waiting for1, but I PROMISE as soon as you get 1 after me you'll be the first one to know!!!

Please don't tell me you've never done METH or drank alcohol...and when you are telling me this i smell ETOH and you have hamburger meat for what is supposed to be the inside of your nose!:lol2:

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Specializes in Emergency Nursing, Critical Care (Heart).
Had a woman ask me if we numbed before IV (she came in for leg swelling w redness, hx PE...what did she THINK we would do?) When I told her that we didn't, except for in kids, on non-busy nights, when we actually have enough rooms that waiting an hour for an IV stick is remotely acceptable, she wigged out on me. Then I get the classic response: "Well, you'd better get somebody good because I only allow one stick, and THEY HAD TO CALL ANESTHESIA LAST TIME" In the 3 years I have worked there full time, I have never needed to call anesthesia on anyone, nor have I heard of them actually doing it for a hard stick. People with veins that crappy that need an IV that bad get CENTRAL LINES people.

As a side note, I don't care if someone wants to say "I don't have the best veins, and I'd really appreciate it if you could put your best person on it." in a nice tone of voice. But the whole ONE STICK AND GET OUT thing just ticks me off.

I agree 100% with your comment. It just doesn't make a lot of sense to me for a patient to come to my place of business and tell me how to do my job, much less dole out ultimatums. I can't help but become defensive when I hear this sort of comment. "Excuse me, but I have been starting IVs for 11 years and never has it been my desire to poke someone as many times as I can; I have much better things to do." For you to tell me that you are only allowing one stick tells me your not that sick. Hmmm.

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