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 6 years of ER fun, med/surg, blah, blah.
Being a student nurse and unsure of the exact area I want to work in, is it wrong I now want to work in ER MORE after reading this entire thread?

But in all seriousness you ER Nurses seem like a wonderful bunch. Hopefully someday soon I'll get the pleasure of working with you!

Come on over you crazy fool! You'll love the ED. Never a dull moment!:lol2:

Specializes in Tele, ICU, ER.

Nice thing about ER nursing is, no matter how miserably bad your night has gone, by the time you clock out, you have that "man did we kick some butt last night!" feeling, and drive home knowing you gave the best care available under conditions that would flatten most folks in a heartbeat.

That said... I'd still prefer if folks didn't...

...Show up christmas morning at 4am cause "maybe I think I could have a yeast infection".

...Say "I'm a nurse and my SO/kid/whoever is REALLY sick" and I find out you were a CNA 15 years ago in highschool, and NOT a nurse. And the person you brought in is just drunk... again.

...Hand me a list of medications and as I'm listing them on the form, start saying "Oh well I don't take that one anymore, and that one there I take more now but I don't know how much....". Darn it - if you are going to HAVE a list, UPDATE it please.

...get shot by "some guy" and insist they want to sign out AMA, when the cops are standing there looking at the bullet on the xray.

...bring in their elderly home care mom, sopping wet out of the car, and jump up and down in the waiting room that she needs a room cause her diaper needs changing - when they've brought her in for confusion, and she's an alzheimer's patient and it's Thanksgiving and they have to get home cause the turkey is in the oven.

Specializes in Emergency.

My current new rule:

Please bring in Grandma/Grandpa's pill bottles. No, I cannot tell by color and shape which pill they are (actually some I can). No, my eyes aren't much better than yours, and I can't read the print off the side.

This happened twice last week and these were some seriously ill people.

I can think of only two rules.

1. This is not a hotel and we are not your slaves

2. The world does not revolve around you--chest pain is always more important than the hangnails, and getting your kleenex or coffee or whatever!

Specializes in Pediatric Pulmonology and Allergy.
Specializes in ED tech on a resp. therapist adventure.

If you/your SO/child wear diapers or depends please bring extra with you.

We had a lady last week who wears depends and was there for diarrihea, had an "accident" and her spouse comes up (they had been triaged but not yet taken into the back) and asks for a pair of pants and a new pair of depends. Then later she did the same thing all over again.....Frustrating....

WOW! I am not an ER nurse by any means...but I can definitely understand most of these "rules" but do you really not care about pain unless it is chest pain? I am a kidney stone sufferer, and while yes, I know I am not dying from this pain, at times I wish I would so I wouldn't have to feel it anymore. My last stone was 8 mm and I really thought I was gonna pass out from the intense pain, but luckily for me, my ER nurse valued my pain!

I feel the exact same way. I am also a kidney stone 'sufferer' and I'd hate to think any nurse or health care provider wouldn't value my pain. Pain is pain is pain. If someone is having a heart attack, obviously it's way more important that pain from a stone, BUT it doesn't minimize someone else's pain.

Please oh please DO NOT come in for a pimple to your right nare! This is a waste of everyone's time including yours, however, thanks for the laugh.

Lmao! That's a good one! :lol2:

I feel completely sane. I've been out of the "real" ER scene for almost 3 years, now Director of a small ER and short stay surg. unit. I'm glad to read all your rules for ER patients/staff etc..., I had all those same thoughts for the 13 years spent in the "real" ER's. Remember these also? One patient per family; one visit per day; one complaint per patient.

Specializes in Emergency Room.

why, oh why, do we have to put up with you for 3 days in a row? etoh >500, good samaritans calling 911 cuz your ass is face down in a puddle.... you come in incontinent of b/b...... you scream and yell before you finally fall asleep, and take up an ER bed for 8 hours to sober up. What happened to the "drunk tank"? now it is our job, and I don't like it at all. We have to discharge you with enough etoh in you system so you don't have a seizure, but not enough so that you don't walk out into traffic in front of the hospital an have all of your "family" (who have not spoken to you in 30 years) sue us because you left the ER drunk and got your self run over by an innocent driver.

What do you mean you think a tampon is in "there" for x amt of days. Jeez Louis!!!!!! There is no way I couldn't get a tampon out by myself! How big are you??????????????? Is there an echo?

If I take back an 80 yr old man with a complaint of weakness/dizzy (who turned up to be a GIB with a HGB of "almost dead"), how DARE YOU accuse me of this being a "BLACK/WHITE THING" because you were here "first" when you are here for c/o knee pain for 5 months. You have now pissed me off to the ends of the earth, and I will tell you it is not a "BLACK/WHITE THING", but rather an 'orangish,reddish thing". and you will endure a "therapeutic wait" I can't tell you how much this guy pissed me off. Entitlement? only a little. Burger King? Not here, dude. People who use "racism" as an excuse to demand special treatment seriously PISS ME OFF!!!!!

Ah ,the "wait"......... If it is life threatening (which is what EMERGENCY rooms are for.......) none at all. If it is because you have placed an item in an orifice which is an exit only orifice (and you had to TAKE YOUR CLOTHES OFF TO GAIN ACCESS TO SAID ORIFICE) .........possibly hours. Hopefully the batteries will run out before you see the Dr.

If you are an 80 yr old male with C/C abd pain, and after assessing you , you tell me " Nurse? did I tell you I have diarrhea?" I will seriously duly note this, until you tell me "It runs in my jeans" and laugh. Then I will duly note you as a "non complainer",,,, I will love you to death, and watch over you as carefully as if you were my own father. Because the non-complainers are the ones who will crump on you faster than you can blink.

... Because the non-complainers are the ones who will crump on you faster than you can blink.

Ain't that the truth!

I have had experiences with bad, rude, mean ED nurses, too. However, as a street paramedic and student nurse I can also say that most are truly caring and deserve highest praise. Just because you vent does not mean you don't go back to work the next day and treat each patient with the best your training has to offer. If we don't have a safe place to vent we might just explode. I've been forced to transport the guy who had a sore rectum from picking out hard stool. No matter that it took the last ALS ambulance in two counties out of service for 2 hours. He didn't care. He knew his "rights". Even being told that his insurance wouldn't pay for the ride didn't matter. (We never did get paid for that one). Take my word for it, I apologized to the ER nurse I turned him over to. I wish they HAD ordered him to the waiting room. While we were tied up with this joker there was another man in our area that nearly died from a massive GI bleed because he had to wait nearly 40 minutes for an ambulance from another area to arrive, plus transport time.

My point? We all see very sick, very needy patients every day, but all too often we see stupid or selfish ones. I give utmost kindness and compassion to those who aren't so much really sick but are scared. I go out of my way to be helpful, compassionate, make them comfortable, etc. I just don't appreciate those who abuse the system. The phony chest pain who calls 911 when her husband makes her mad, then expects us to transport her back home because he might be cross with her and so doesn't want to ride with him. If it were a case of abuse I'd understand, but after the first 10-20 times I get cynical. I am happy to go check a child who has fallen and mom is scared. Not so happy when another mom calls us during the worst ice storm in years because her son has had an earache for three days, (she didn't take him to the pediatrician because she didn't have time), and doesn't think it is safe for her to drive him to ER. The earache isn't worse, she just thinks it better be checked out. We were scared to death that we would, with all our weight in that giant box, accidently strike someone else. It wasn't safe for us, either. I'm not afraid for myself, but for those we encounter. So, am I a bad medic who will make a bad, mean nurse? Nope. I just filed her and the other guy under my category of "too stupid to breed" and when the next earache comes in I give all my best. I strongly suspect the ER nurses who have vented in this thread do the same. I'm glad they do vent. It keeps them on the front lines longer with less of the burnout we see in those few truly mean nasty nurses that are out there. God bless each one who keeps going back to their job (calling) with grace.