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.

[Balder_LPN, LPN]

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!")

As fun as the rules on this thread have been (and I have loved them all, even thought I got a good one in myself), the title is "Rules for the ER" it doesnt specify pt's or nurses.

I never realized that you weren't welcome on this thread without recent ED nursing experience. I work in an ED, and am a student nurse in addition. (not "just a student" as they usually say around here), is my contribution no longer welcome or valid? (come on, $25K in your underwear is pretty funny)

Can't we all just get along:lol2:

[33-weeker]

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.

AMEN!!!!!

[33-weeker]

33 weeker,

you came to our "fun vent" thread and gave us some "rules" and advice on how to do our jobs.

the following is a quote from you on the "ob rules" thread:

i know we birthing unit nurses can have rather sharp tongues when it comes to venting, but we really are just blowing off steam. we need to blow off steam in a venue like this so that we can be kind to our patients to their faces.

and another thing, you have no clue to what i can take....

i am an er nurse!

i'm not saying you can't vent. i've enjoyed reading this thread. i'm not an ed nurse, but i have been a nurse for a long time, so i can relate. i was just having fun with rules from the patient's point of view. don't take it so seriously.

[33-weeker]

Ok, had to comment on this one from several posts back. (Sorry, just read the thread.)

"So let me get this right, you're kid was asleep, woke up, threw up once, and is fine now, and you brought him out to the ED at 2am?

"Yes. . . Who get this?" (handing me the kid's Medicaid Card.)

(Under my breath), "We all do."

2. You can't beat the woman that waited hours to get a script for a 1.50 bottle of OTC motrin so that 'Medicaid would pay for it'. Hmmmm. They don't. Boy was she tweaked! "How am I gonna afford it then?!"

(again, under my breath) "Try spending less on the 'do and two-tone nails."...

All too often the root cause of ED abuse is an 'entitlement' society. Society owes me, man. Whatever.

~faith,

Timothy.

AMEN!!!!

We've had problems with medicaid/no-ins. patients getting angry when we won't give them a private room unless they pay the difference out of pocket.

How many times (after being forced to file bankruptcy over my own family's medical expenses) I've wanted to say, "well... it's just one of those pesky facts of life... you get what you pay for..."

[desertrn]

I am an ED nurse adding my 2 cents.

Yesterday.....

A 400 lb abd pain pt. brought in by ambo who's first requests were for a telephone and food.

A mother and her 4 children with runny noses.

A women with a severe headache who came to the middle of the nurses station screaming that we were too slow. Tryed to take a swing at the Dr.

then called 911 from her cell phone and told them the Dr. pushed her.

(escorted out by security)

A women with a bug bite on her leg, a medication list from home which included 5 pain meds. Then demanded an RX for more. (didn't get any)

Left cussing and swearing at us.

A 21 yo male with ETOH. pissing all over the wall and cabinet next to his bed.

A 40 yo rad tech who shot himself in the head in the parking lot. (didn't make it)

All this while working short staffed and learning a new computerized charting system with no prior training. Just another day in an inner city ER!

Glad I'm off today to recover. Thanks for listening.

[andhow5, BSN, RN]

How about:

When you drink, then drive a car underneath a semi, knocking the semi's rear wheels off, and having your passenger drug several hundred feet smashing their body into the dashboard (so as to render ID or even gender next to impossible), don't come in trying to take a swing at the nurses or demand that the police leave...

[Hellllllo Nurse, BSN, RN]

Much support & respect

to all the ER nurses.

Although I've never worked ER, I've been a nurse for many years. I'm sure a lot of non-ER nurses can identify with many your postings to one degree or another.

And I will say again- I'm soooooo sick of students judging seasoned nurses.

In a few years, the righteosly indignant posters will be posting their own ventings. Then, future nurses not yet in elementary school will be righteously indignent with them.

[Hellllllo Nurse, BSN, RN]

So, there I was... feet throbbing, back aching, bladder distended and screaming for relief, stomach rumbling, eyes dry and scratchy, mouth and lips dessicated and cracked from 10 hours with no fluids, uniform damp with perspiration and splattered with blood from a flailing demented man 2 hours ago (okay, also maybe a little bit of a white deodorant stain begining to show around the armpits). I stumble onward, though, proud to be on a mission to deliver the little, fancy cup of PO meds to a sick granny. A smile on my face, but not so big as to cause my dessicated lips to crack and bleed, I explain the medicine to my patient and gingerly pass the cup into her ever so eager hands. "Just lift the cup to your lips and dump in the pills," I say, coaxing her softly. Granny nods, smiles back, then takes a priming sip of the ice water as I secretly fantasize about thrusting the water to my own lips for a few greedy gulps. I look back at Granny and nod. She's ready to take the pills....a dramatic pause....and then.....NOOOOO!!!!! Too late! She has already disobeyed and is now overturning the little cup of precious pills into her gnarled, arthritic, coumadin-bruised, parkinsonian-tremor hands! I dive to the bedside, a desperate attempt to at least keep the pills somewhere on the bed. "Ooops!" She says with that cute little old lady giggle. I am able to recover the pills and place them back, safely, into the cup. Phew, a close one. Still patient, I reach to hand her the water but when I turn around, the greedy gnarled fingers have already been digging in the cup trying to get the pills out! The white pills (it's always the white pills) have bounced out and onto the bedsheet! "Don't move", I instruct as I search for the missing offenders. This is when granny's family crowds in and starts moving the bed up and down and flipping the sheets around to "help." The pills start plinking musically to the floor right at that moment. I sigh and go to see what pills are left in the safe little cup. Meanwhile, granny and her magically gnarled finger (that is almost the same circumference as the cup) has managed to somehow dig more pills out and actually get some in her mouth. She chewed them a little and then spit out "the bitter shells" as she put it. Pill fragments are now everywhere...on the bed, on the wall, on me. Lord help me, it's like pill pirrannas were here! The front of my uniform is now speckled with debris. Hmm...Despite dehydration, the vein on the left side of my neck is now distended and throbbing, and I feel what could be horns? starting to grow out of my head....Face red, I reassure granny that all wll be made right as granny's family starts demanding that it "took so long to get the pills, now we'll be here forever! We need blankets, and a phone, and food, and blah blah blah!" Also it the faint distance....I hear a voice...."Nurse! I need you to get over here and start an IV on this hyperactive 5 year old, get a stat NG in room 6, and did granny smith in room 11 get that medication yet?!?"........

I can soooo relate to this!

Especially the parts about the desicated lips, aching feet and back... and the pt's water cup looking soooo good. And... why does every elderly pt dump the pills into their hand or try to dig them out of the cup no matter how many times you tell them how to take the meds?!?!

[nursebearfeet]

this should be fun, here's my list

1. if you are in my er because for some reason you "can't breathe" and you are outside smoking when i call you to be seen, I have express permission from GOD to taze you.

2. If you are able to complain (LOUDLY) to the unfortunate party on your cell phone about how slow we are and how poorly you've been treated, you may now thank your lucky stars you're well enough to complain.

3. DO NOT tell me you can not a) afford your prescription or b) get home, if you have a cell phone in your hand, are wearing jeans that cost more than I make in a week, have acryllic nails complete with $100.00 nail art, a fancy hair do, are clutching a coach bag, smoke/drink/drug, or the price of your shoes could have feed a small village for a month because frankly, i dont care. get your priorities straight. p.s. if you go to mcdonalds, they dont pay for you to get home, neither will I.

4. please for the love of God and all the angels do not take an ambulance for your URI because you think you will be seen faster. Some one may DIE because the ambulance YOU are occupying is out of service due to your cold.

5. I was a waitress once. ONCE. I made more money then.

6. you are only allowed to pee on your self if you are an invalid or unconscious, not to get even with me because i was with another patient when you called.

By the way if you wipe your own rump at home you will here too.

7. if you systematically eliminate all but the choicest drugs due to ALLERGY, you will get ultram and LIKE it.

And a parting piece of advice, be nice to the person who medicates you, or there may be an 18 guage needle in your future.

[nursebearfeet]

With all due respect I never jab an uruly patient with a larger than required needle for fun no matter how I may daydream about it. I dont know what your profession is but if you have never held a beautiful child as he takes his last breath and then had to tell his mother that her precious child is dead, dont judge me. Or had to tell a woman that has never been separated from her husband in the 67 years that they have been married that despite your best efforts ( and i mean best) he didn't make it. or if you have never had to tell a teenager and her parents that yes, we did have to amputate and no you probably will never walk again, DO NOT assume to know what it is like. Do not judge us for the need to vent about patients who waste our time when there are those who desperately need our skill.

we are not being "mean" we have to cope like any one else, and for many of us these forums are a place for us to do just that. it is not meant literally or to offend.

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!!!!!!

[twotrees2]

LOLOL that reminds me of when i first became a nurse , had passed boards and was finally off orientation - a man came onto the floor from ER - as i am about to give his hypo in walks his wife ( one of my old classmates that was less than nice wayyy back when ) and she says to me " now thers something wed never think T.K. would ever make of herself - ANYTHING" - i would have LOVED to shove tht nice hypo right up her orifice and do it hard lolol - but the professional i am told the hubby ( who by nnow is looking at me and the needle with horror as his wife so rudely bashes me and looks at her like " honey shut up shes got a needle lol" ) its ok - im a great nurse and i will tke good care of you regardless of how rude your wife is,.... ok so that wasnt so approriate even but i HAD to say something lol. i was new and green and angry - handled it quite well for back then - now it means nothing to me if i hear a nasty remark but that statement has been with me since i heard it........................ i did get a positive remrk on the exit review :) totally surprised but the hubby really thought i was a good nurse i guess. like to be a fly on thier wall.

this should be fun, here's my list

1. if you are in my er because for some reason you "can't breathe" and you are outside smoking when i call you to be seen, I have express permission from GOD to taze you.

2. If you are able to complain (LOUDLY) to the unfortunate party on your cell phone about how slow we are and how poorly you've been treated, you may now thank your lucky stars you're well enough to complain.

3. DO NOT tell me you can not a) afford your prescription or b) get home, if you have a cell phone in your hand, are wearing jeans that cost more than I make in a week, have acryllic nails complete with $100.00 nail art, a fancy hair do, are clutching a coach bag, smoke/drink/drug, or the price of your shoes could have feed a small village for a month because frankly, i dont care. get your priorities straight. p.s. if you go to mcdonalds, they dont pay for you to get home, neither will I.

4. please for the love of God and all the angels do not take an ambulance for your URI because you think you will be seen faster. Some one may DIE because the ambulance YOU are occupying is out of service due to your cold.

5. I was a waitress once. ONCE. I made more money then.

6. you are only allowed to pee on your self if you are an invalid or unconscious, not to get even with me because i was with another patient when you called.

By the way if you wipe your own rump at home you will here too.

7. if you systematically eliminate all but the choicest drugs due to ALLERGY, you will get ultram and LIKE it.

And a parting piece of advice, be nice to the person who medicates you, or there may be an 18 guage needle in your future.

[Noahm]

These are great you guys keep them coming!! I'm seriously doubting that I could ever handle ER nursing! I think I need to start a rules for the med-surg floor thread though. These threads are great.