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.

[CoolhandHutch, MSN, RN]

It's things like this that make me afraid of Nurses!

You sure it isn't the needles?

[Miss Mab]

You sure it isn't the needles?

Or, maybe it's the perpetual multi -tasking shin dig that we did/do so well.

We're like whirling dervishes--freaks the faint hearted out.

As my favorite NP would say--MAN UP people!

[Jen2]

To the people that think ER nurses are bad nurses:

1. When you get a husband and wife trauma and the husband dies in the trauma bay next to his wife and you pull her gourney over to his so that she can be near him and greive, and then you pull of his bloody wedding band clean it up and hand it to her, YOU COME BACK AND TELL ME I AM A BAD UNCARRING NURSE.

2. When you work an 8 year old traumatic arrest for an hour and the beautiful child dies in front of his parents and you do castings of his hand prints and cut off locks of his hair to give his parents, YOU COME BACK HERE AND TELL ME I'M IGNORANT.

3. When it is your family member or loved one that is dying and I am coddling a frequent flier, drug seeker, or belly pain, you can then come and tell me how bad of a nurse I am. Guess what? That ain't happening. Not in my ER anyway because I am with who needs me. I am trained to know that. I can tell who is sick or who can potentially become very sick. Honest I can. Have I been wrong? Yes! The times I have been wrong have been the times that I have over shot a patient condition, not undershot it.

To all the wonderful patients that help me bring home the bacon:

1. Come and see me CHF'ER after you just downed half a ham, smoked a cigarrette while walking from the car to the triage area and now you can't breath because you are in failure again. Job security.

2. If I am in triage and you come in eating a Subway sandwich complaining of belly pain and then proceed to ask me how long the wait is becasue the football game comes on at noon. Yes you are automatically going to piss me off. Yes I will be very blunt with you and tell you that with your compliant you will need to put that sandwich down, becasue when I get a room available for you you will get at least an 18g IV, labs, and then if they all turn out normal you will need to have a belly CT with lovely blueberry flavored contrast and have to wait an additional 2 hours after you drink it for your CT and it will probably be hard to get down after a foot long steak and cheese!

3. If you are 30 years old old and come in complaining of chest pain I will need to cut off your 3" acrylic nail so that I can get a proper O2 sat, becasue we take that complaint pretty seriously in the ED.

4. If you even think of hitting me I have the right to defend myself and will. You will be strapped down in 4 point leather restraints, spit mask and drugged before you can even finish the words F*&^ing Bit$#.

5. If you decide to cough in my face while I am trying to start an IV I will politely ask you to cover your mouth. People get so offended when you ask them to cover their mouth when they cough.

6. If you pull the curtain and ask me for a glass of water when I have sweat running down my face because I have been doing compressions for 15 minutes straight because the rest of the staff is doing the same in other rooms you are almost gaurenteed to not see a drop of H2O for the rest of your stay.

I think thats enough for now. Whew I feel better. It's been a tough couple of days.

[Altra, BSN, RN]

To the people that think ER nurses are bad nurses:

1. When you get a husband and wife trauma and the husband dies in the trauma bay next to his wife and you pull her gourney over to his so that she can be near him and greive, and then you pull of his bloody wedding band clean it up and hand it to her, YOU COME BACK AND TELL ME I AM A BAD UNCARRING NURSE.

2. When you work an 8 year old traumatic arrest for an hour and the beautiful child dies in front of his parents and you do castings of his hand prints and cut off locks of his hair to give his parents, YOU COME BACK HERE AND TELL ME I'M IGNORANT.

3. When it is your family member or loved one that is dying and I am coddling a frequent flier, drug seeker, or belly pain, you can then come and tell me how bad of a nurse I am. Guess what? That ain't happening. Not in my ER anyway because I am with who needs me. I am trained to know that. I can tell who is sick or who can potentially become very sick. Honest I can. Have I been wrong? Yes! The times I have been wrong have been the times that I have over shot a patient condition, not undershot it.

To all the wonderful patients that help me bring home the bacon:

1. Come and see me CHF'ER after you just downed half a ham, smoked a cigarrette while walking from the car to the triage area and now you can't breath because you are in failure again. Job security.

2. If I am in triage and you come in eating a Subway sandwich complaining of belly pain and then proceed to ask me how long the wait is becasue the football game comes on at noon. Yes you are automatically going to piss me off. Yes I will be very blunt with you and tell you that with your compliant you will need to put that sandwich down, becasue when I get a room available for you you will get at least an 18g IV, labs, and then if they all turn out normal you will need to have a belly CT with lovely blueberry flavored contrast and have to wait an additional 2 hours after you drink it for your CT and it will probably be hard to get down after a foot long steak and cheese!

3. If you are 30 years old old and come in complaining of chest pain I will need to cut off your 3" acrylic nail so that I can get a proper O2 sat, becasue we take that complaint pretty seriously in the ED.

4. If you even think of hitting me I have the right to defend myself and will. You will be strapped down in 4 point leather restraints, spit mask and drugged before you can even finish the words F*&^ing Bit$#.

5. If you decide to cough in my face while I am trying to start an IV I will politely ask you to cover your mouth. People get so offended when you ask them to cover their mouth when they cough.

6. If you pull the curtain and ask me for a glass of water when I have sweat running down my face because I have been doing compressions for 15 minutes straight because the rest of the staff is doing the same in other rooms you are almost gaurenteed to not see a drop of H2O for the rest of your stay.

I think thats enough for now. Whew I feel better. It's been a tough couple of days.

Amen, sister.

Oh, and my own thought for the day ...

I am very conscientious about telling my patients & families what "the plan" is. I tell you roughly how long it's going to take, when I can. When I can't, I tell you very explicitly that I can't give you a time estimate. No amount of subsequent *meaningful looks* from you will change the plan, nor will it magically produce some different, shorter time frame. Telling me, "I know you said we were waiting for ___ but my mom's getting fidgety" DOES NOT CHANGE THE PLAN, DOES NOT MAKE THE LAB, RADIOLOGY, ETC. MOVE ANY FASTER. Believe me, if we're even having this conversation, your mom is NOT CRITICAL and therefore not the highest priority. The idiosyncracies of your family dynamics were your own problem before you & I crossed paths, and they will continue to be your problem, not mine.

[traumaRUs, MSN, APRN]

All Nurses (and especially this thread) is for venting. I am truly sorry if anyone is offended. However, ER RN's (the intended audience of this thread), truly know what it is like to work 12.5 hours without food, water or even a kind word.

To the folks that are offended, it was not intentional. I do feel that here amongst our own, we can let our hair down.

I am so proud of my 10 years in a level one trauma center. So many of these posters echo my feelings. I feel I was so lucky and humbled to be a part of someone's life in such an intimate way. I also was very blessed to work with co-workers who I could laugh with, cry with and yes, vent (in sometimes inappropriate words too).

Please know these are some of the kindest, most intelligent and caring nurses I have ever had the pleasure to work with!

[RunnerRN, BSN, RN]

I apologize if these have been repeated:

1. If your nurse hasn't seen you for 15 minutes, make sure to remind everyone on staff. Sometimes they sit in the breakroom and forget about all of their patients.

2. Just because one patient is coding, and two traumas are coming in, be sure to tell us when your girlfriend (with the twisted ankle) wants a warm blanket and ice water. That always takes top priority.

3. When waiting for a room upstairs, be certain to check at the nurses station every five minutes. The hospital always keeps spare room for pt's that complain loud enough.

4. If you've been waiting long, just walk into the doctor's dictating area and ask personal questions. They have just spent five minutes with you; you guys are old friends! Edit: once you get home (a week later), if you have any questions, feel free to call the ER and ask for the Dr. by name. I'm sure he/she will remember you and drop everything to take your call.

5. That pain that has been nagging you for months is always best fixed in an emergency room!

6. Always refuse to see a PA/NP and ask for a doctor only. Especially if you don't know what an NP/PA is.

7. Even though you've been diagnosed with diabetes and have a BS of 500, ask for something to eat. Hospital food - especially in the ER - is very tasty. Sometimes even catered.

8. Even if you don't have a high BS or diabetes, ask for something to eat. Nurses love to bring food for patients. Waitressing in covered - in depth - in nursing school and those pesky meds can wait.

9. After arriving by ambulance in the ER, refuse all treatment for you/your mother/ your child/ except for PO meds. Anything that can be done to you (IV's, resp treatments, minor surgery) can be solved with a PO medication. ER nurses just do the painful stuff cause they are 'meanies'.

10. Tell the nurse starting your IV that you tend to hit people when you get stuck with needles, and you can't control the reflex. This way, he/she will be extra careful when starting the IV. Otherwise, they don't even look for good veins.

11. Finally, call ahead to the ER and ask what the average wait time is. The ER is like a restaurant and can tell you - to the minute - how long it will take to be seen. As a matter of fact, just make a reservation. Bring a couple of extra bucks to tip the triage nurse/host/ess. Good taste goes a long way.

12. Oh, yeah. For those of you taking 5-10+ medications. Don't worry about keeping track of the names and dosages of your meds. There is a universal computer system that every ER has access to that will look up your own personal prescription history. Besides, if you tell the nurses the colors and shapes of your pills, they will automatically know what you are talking about. They learn that stuff in school!

Disclaimer: please don't flame me too hard, I'm just a lowly ER tech!

CrazyPremed

:lol2: :lol2: Thank you for helping us bring this thread back to where it started! These were wonderful!

By the way, all of these meanie responses remind me of a saying an old ER preceptor taught me....

I HAVE MORE orifice THAN YOU HAVE TEETH!!!

I didn't know the true meaning of that until I actually got into the ER and working for a few months. HAHAHA :) Let's just say I weigh exactly the same, with the same proportions, as when I started...but my orifice has magically enlarged :)

[desertrn]

Love this place!

[TennNurse]

Truely, if you aren't an ER nurse, or haven't been one in the relatively recent past, you have no reason to come into this thread. It can make an awful day even worse when you come into this thread to read some venting ("YES! Other people understand how I feel!") and see responses from those who are trying to make us feel bad.

As many of us have tried to explain before, ER nursing is a completely different animal than any other area of nursing. We work in a wildly different environment than others, and have to be versatile and ready to change our thinking patterns in a second (when that "shoulder pain" turns out to be chest pain radiating to a shoulder, or you code a 2 year old, try to console his parents, then have to walk into the room of a 26 year old "ankle pain" who tripped while drunk last night, has a negative xray, and can't do anything but complain about "how long it took you to get in here and see me, and I need pain meds, and I want food, and you have to give me a cab voucher because I got here but I can't get back home.")

We would all appreciate it if you didn't try to ruin our venting and fun. If you'd like to start a thread "Rules for ER nurses from former patients" on our forum, please feel free. But don't come into this thread and make comments that are sure to provoke comments, and eventually get this thread shut down.

:yeahthat: :yelclap: :thankya:

THANK YOU!!

Silly me, I thought this was a thread for ER nurses to vent amongst those who would understand and commiserate. I personally have enjoyed this thread so much that I have recommended it to my comrades in battle. How many times must it be said, that if you want to whine and complain about your experiences as a patient in the ER, START YOUR OWN DADGUM THREAD!!!!

To all those who have contributed their woes as ER NURSES, thank you, and God bless. I am one of you, and 99 days out of 100, I feel your pain. It is the 15% that are sick that we are there for, the ones who take our hands and say, "Thank you." Even the nervous new parents of a perfectly healthy baby, who rush in needlessly, and right after they thank us for understanding and caring, they apologize for coming in the first place. It's OK, we've been there, too, or will be sooner or later.

This is a challenging area to work, mostly rewarding, often frustrating. People who whine, bit*h, and criticize our coping methods, just please stop for one second and consider how much worse off you'd be without us. We are able to provide the excellent care we do largely because of this hallowed place where we can vent amongst those who understand us.

And to the poster who indicated that bad ER care was "the norm"... :angryfire :angryfire :angryfire Have you any notion how much trouble I personally go to in order to track down the doc who ordered your NG tube so I can request some Ativan prior to insertion? Or that there is one MD who is so notoriously bad at pelvic exams that I move mountains to make sure that he doesn't do yours? Or the number of times I've risked the wrath of administration by sneaking online in order to print off information on your newly diagnosed, rare disease? Or how often I just know that you don't look good, and put your chart in the front of the rack? Or the number of times that I badly need to pee, but instead use that precious 5 minutes to give an overview to a newly diagnosed diabetic and recommend the most informative reading material? Or how many times I've taken time I don't have to console a miscarrying mom? Or taking extra time to baby along a child who needs an IV so she's not so terrified of it? Not to mention getting in admin's face to send me some help when you are so sick that you need my one-on-one attention instead of sharing me with 3 other patients. The list goes on.

OK, I've regrouped and can now calmly recommend that if you still truly feel that bad care is the norm, GO SOMEWHERE ELSE. Your PCP, for instance.

[canoehead, BSN, RN]

Just tonight a Dad complained about the wait and called us "just a Bandaid station" immediately after we coded and saved a 65yo who had to be defibrillated 5 times. His 3yo daughter with stomach pain and fever was sitting in the lobby eating crackers and peanut butter. I gave her Tylenol (because she didn't get any at home) and set her up with a drink as the flight crew flew by with their stretcher. What does he think we were doing in there, darning socks while his poor honey waits?? People like that make me tired of this work even if I know THEY are the jerks.

[nursejohio, ASN, RN]

I'm not an ER nurse, don't wanna be one. You guys do the job the rest of us have nightmares about and come back for more, even after taking all the abuse at work and online for blowing off steam.

I've been to the ER as a patient and a family member multiple times. If we were there long enough to get antsy, it was a good thing, because that meant that we really weren't that sick *as stated in the OP*. If we got brought straight back, it scared the hell out of me, because I don't wanna be any part of getting triaged to the front of the line. I got cranky after waiting long amounts of time, but I understand that's because sicker people get priority over whatever brought us in that day. I'd never dream of doing (or letting whoever I was with do) the things some of you have written~

Kudos to you all for everything you do, rude or not :rotfl: ... and keep the posts coming!

[jayne109, RN]

Here is another rule we came up with on my shift:

If you are allergic to milk, don't call an ambulance because you are nauseated and vomiting because you ate 2 big bowls of ICE CREAM 2 hours before and then proceed to tell the nurse that is checking you in that ice cream does not contain milk and oh by the way can you have some pain meds for your 18 y/o back that is hurting! you won't get any sympathy or Demerol!

We had this the other night and the pt looked at the nurse like she was nuts because she tried to tell him that ice cream was made from milk. Some people never learn.

[Lurksalot, BSN, RN]

Please do not sit there nodding and smiling at me as I speak to you in your primary language and in english. Do not nod & smile as I ask if you 'understand' and 'comprende' if you really do not understand or comprende. Do not pretend you understand the two doctors who were speaking to you in your language if you did not really understand. One phrase will work, sir-- "NO COMPRENDE!"

I really, really would rather get our roaming interpreter than find out you have no clue what is happening. Thank you.