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.

[rgroyer1RNBSN, BSN, RN]

do not come in and tell me you are having abd pain and vomiting blood if you arent because you will get an NG and its not pretty.

[rgroyer1RNBSN, BSN, RN]

I agree with you astro I've been starting IV's for awhile now and if you throw that big of fit over an IV stick then you arent that sick.

[rgroyer1RNBSN, BSN, RN]

I agree with nurseerica do not judge us, unless you have been a nurse and do what weve been doing unless you have 2+ years er exp.

[blueyesue]

I have read a few pages of this thread as I have been checking out the specialties on here to see which one I may be interested in when I graduate. WOW! You sure deal with a lot of hardships. Do you sometimes just want to walk away and try a different area? What is it that holds you to the ER? It seems like one of the harder areas to work in because many of the patients are not even sick, and waste your time. Would you say that 90% come to the ER for legitimate reasons, or more like 50%?

[jojotoo, RN]

I have read a few pages of this thread as I have been checking out the specialties on here to see which one I may be interested in when I graduate. WOW! You sure deal with a lot of hardships. Do you sometimes just want to walk away and try a different area? What is it that holds you to the ER? It seems like one of the harder areas to work in because many of the patients are not even sick, and waste your time. Would you say that 90% come to the ER for legitimate reasons, or more like 50%?

What makes any of us want to be an ER nurse? Or want to stay an ER nurse? What makes someone want to be a Navy SEAL? Or belong to the SWAT TEAM? Or jump out of airplanes? Or train to be an astronaut? Or boldly go where no man has gone before? Part of it is the adventure. Part the adrenaline rush. Partly feeling as if you belong to an elite group. Each of us probably has a different answer or combination of answers. But for most of us, once it's in our blood, we can't imagine doing anything else.

My estimate of truly sick ER patients is 15%. But that's the 15% that I'm there for. That's where I will actually make a difference in someone's life. And for those few, I am willing to wade through the bullshit night after night.

[blueyesue]

But that's the 15% that I'm there for. That's where I will actually make a difference in someone's life. And for those few, I am willing to wade through the bullshit night after night.

Excellent answer. Too bad they couldn't have an ER for "almost sick" people. A place where the CNA's, nursing students and docs in training could "practice."

[Imhappiwitu]

FOR ER NURSES

1. We know that you have a tough job, but it isn't professional to complain in front of the patients. It makes us think badly of you.

2. Wait till the alcohol dries before giving that shot. We know what you are doing.

3. When we tell you we have a rare disease or condition, we prefer you look it up rather than act as if you know what it is.

4. Don't pretend you didn't hear us. We know you did.

5. If you are rude, we will remember and spread the word. However, you must remember that it is because of us that you get paid. We are your customers. Treat us accordingly.

6. We hope you are having a good day.

7. We remember the really good nurses, and the really bad ones. The average are long forgotten.

8. Nurses are kind, considerate, patient, and compassionate. If you are none of the above, then you are probably in it for the money. We don't need you.

9. We don't want to be here either.

10. Don't laugh and talk about us so loudly. It isn't nice. And no, you didn't earn that right.

11. Tell us our BP. It is our body, not some secret to be kept to yourself.

12. Smile. It is good for you, and it spreads to others.

13. Kind hearted nurses ROCK!!!!!!

[flashpoint]

4) Do not tell me Ive had this before and this is what you guys do for me.

I don't always agree with this one...I get kidney stones once or twice a year and I always tell them what works for me. Morphine does not work...demerol does not work (but they both make me VERY happy). Toradol on the other hand, works very well...and I don't end up with a headache like I do when they give me the narcotics.

I know the "this is what you do for me" comments get pretty tiresome with the seekers, but it helps to know what works sometimes...

[blueyesue]

I don't always agree with this one...I get kidney stones once or twice a year and I always tell them what works for me. Morphine does not work...demerol does not work (but they both make me VERY happy). Toradol on the other hand, works very well...and I don't end up with a headache like I do when they give me the narcotics.

I know the "this is what you do for me" comments get pretty tiresome with the seekers, but it helps to know what works sometimes...

I agree. One time I had an immediate onset of a massive headache at the base of my skull. I went to the ER and couldn't even talk. They gave me a shot of some drug in my butt. In a few minutes I was in lala land, but the pain was gone. About a week later I was out of town with my husband and the headache came back something fierce. I immediately went to the ER in that town, and explained what worked last time. He gave me a shot of something else instead. It didn't even touch the pain. I suffered the whole night.

[33-weeker]

1. I know you get a lot of 'seekers' and fakers in the ER, but I am not one. Stop looking down your nose at me like you are suspicious of everything I say. ... innocent until proven guilty... remember?

2. When we patients don't know much about our medical history and our condition, we're ignorant. When we are educated and a thorough historian, we're suspicious. Make up your mind. You can't have it both ways.

3. Just because I bring my child into the ER with an injury doesn't mean I'm a child abuser. Kids fall and get hurt. Once again, quit looking down your nose and being suspicious. Be polite until you have a good reason not to.

4. Murphy's Law of Parenting says that kids always wait until Friday evening to get sick, and until Sunday to get injured. Just because I don't want to watch my child suffer all weekend until the doc's office opens doesn't make me an ER abuser. Sometimes it's the only choice I feel I have. (Goodness knows it's NOT the way I want to spend my weekend!)

Besides, if I wait until my PC opens, and there really IS something bad wrong with my kid, then you would just as quickly label me a 'bad parent' who just sat around and did nothing. This is another one of those things that you can't have both ways.

5. If you give me Lasix and you want to record my I&O, give me a 'hat' right away. I will not be able to wait for you once the meds hit my system. If you don't bring it soon enough, don't be mad at me when all I can give you is my best guess.

6. If you bring nitro, bring some Tylenol with it. If not, you might as well turn right back around and chart 'patient refused'.

PS. I have also had some really good ER experiences. Thanks to those of you who really care. We notice.

[LeahJet, ASN, RN]

Perhaps a new thread should be started for the eye opening and informative "Rules for ER NURSES"

Otherwise, the thread is being hijacked and not to mention killing our fun.

Thanks.

[tvccrn, ASN, RN]

Perhaps a new thread should be started for the eye opening and informative "Rules for ER NURSES"

Otherwise, the thread is being hijacked and not to mention killing our fun.

Thanks.

This was tried with the similar OB thread and the "Rules for OB nurses" thread was closed saying that there was already something going like that.

tvccrn