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.

[SANERN]

DO you think we could get these printed in POSTER SIZE for the "clients","customers","guest"..that wait so inpatiently in the ER waiting room?

I think this may increase our SATISFACTION scores if we can entertain them while they wait!!!!

could not have composed a better list!!!

[babynurselsa, RN]

Grammie, you stated it beautifully. You get what this thread is all about. For those who "don't get it" this is probably not a thread that they will enjoy.

I have found this thread entertaining because this is what I live each and every day that I go to work.

THese individuals will never know my frustration when they check in for NONEMERGENT reasons, but that does not mean I don't get frustrated by situations that I do not have control over. I will care for you, I will do it well, but it will not be on your terms.

I WILL prioritize, though that does not mean I do not understand that you are uncomfortable. I will make sure that my chest pain isn't infarcting, and that my flash pulmonary edema is alive and breathing, before I am going to care for your 5 month old sore knee/toe/finger or ear pain. Potentially lethal conditions come first.

I vent so that I can let it go and be the nurse that I need to be the next shift.

[squeakykitty]

DO you think we could get these printed in POSTER SIZE for the "clients","customers","guest"..that wait so inpatiently in the ER waiting room?

I think this may increase our SATISFACTION scores if we can entertain them while they wait!!!!

could not have composed a better list!!!

I would love to see this. Maybe even write a book abut it, a best seller. (I think it would be illegal to tatto it on certain foreheads.)

[LMPhilbric]

One night, we had all hell breaking loose in the ER. We had 2 simultaneous acute MIs, an acute CVA that needed TPA, and only 2 docs on. The one doc was with the CVA, and the other was going back and forth between the MIs. I was taking care of one of the MIs when my other pt's daughter grabs me and says (in a really huffy voice) "Excuse me, but my mother hasn't been seen by a physician yet." I apologized and told her that we had 3 simultaneous emergencies going on and the doc would be with her mom ASAP. In the same nasty voice, she told me "You don't understand. My mother is really sick." Her mom had SOB x 1 week and was doing quite nicely on 2L O2. I looked at her and said "Well, unfortunately, these people are actively trying to die, and actively trying to die takes precedence over 'really sick'". I never heard another word from her.

OK for my ER rules - 1) You, your husband and your 4 children (none of whom speak English worth a damn) with mild coughs and congestion x 3 days have a COLD! I can't fix it. Go home, get Triaminic or Pediacare and wait for 10 days for it to go away. It's a lot cheaper than the $3000 ER bill you are going to get that you aren't going to pay anyway. (The kicker was that the kids had an appt at the pediatrician at 10 AM. They arrived in the ER at 3 AM because they didn't think the kids would make it until 10 AM. Really? You actually thought the kids would die before 10????)

When you tell me you leaving and never coming back, I'm thrilled. Could you take the obnoxious drunk, the drug seeker and the person with the razor burn who thinks they should be priority one with you? Please??

I really don't care how the beer bottle got stuck up your butt. I do care when you lie to me, so please don't tell me that you fell on it.

If you are going to tell me that you only had 2 drinks and you're blood alcohol level is over 300, will you please give me the name of your bartender? That's someone I need to befriend

When you are covered in tattoos and piercings, please don't cry when I come to start the IV and tell me that you are afraid of needles. It strikes me as insincere.

If you have N/V or abd pain and you can pass the "Coke and Cheetos" test, you are not that sick and you can leave now.

[azreddun]

Angry staring, glaring, huffy looks and pissed off body language are not going to make me change the way that I'm getting my job done. Believe me, I feel your misery, your desire to broadcast your feelings is working. I know how it feels to not get my way when I want it, but this is not a restaurant, I'm not a waitress, and if your mother or father was dying, you'd want me to take care of them before I got ice chips or blankets or discharge instructions for another patient. Some days I get so sick of the glaring that I could just puke, other days, I can find the humor in all the grumpy stares, it depends on the day. When I have a really bad day, I just can't get over how little some people care about what happens to others, they want their needs met and that's it, bottom line.

[Sugar9486]

Angry staring, glaring, huffy looks and pissed off body language are not going to make me change the way that I'm getting my job done. Believe me, I feel your misery, your desire to broadcast your feelings is working. I know how it feels to not get my way when I want it, but this is not a restaurant, I'm not a waitress, and if your mother or father was dying, you'd want me to take care of them before I got ice chips or blankets or discharge instructions for another patient. Some days I get so sick of the glaring that I could just puke, other days, I can find the humor in all the grumpy stares, it depends on the day. When I have a really bad day, I just can't get over how little some people care about what happens to others, they want their needs met and that's it, bottom line.

I find that a lot of ED nurses are not very happy to be there, and to be honest if there weren't people coming in there every day there wouldn't be a need for ED nurses. My problem is the nurses who can't so much as give you a smile. Anyone that goes to the ED does not want to be there... especially at 3 in the morning even if some of the nurses think they want to be. I know that I've gotten grumpy A. because I feel like I am an imposition on the nurse then they expect me to respect them when I'm not getting an respect either, it's not my fault that your having a bad day, I wouldn't be there if I wasn't having a bad day and I can treat you like a decent person. B. The nurse can't so much as smile, come on laughter is the best medicine and if you can smile and move on it makes both our lives much easier. C. Most the time I'm in the ED it's for Migraine headache (when my neurologist sends me there because there isn't anything they further they can do at their office and they know I need more help) if I have a headache could you please listen to me the first time I explain things to you, I know we're all human and forget things, but when I hear the same questions over and over again I get aggitated, I have a migraine I would like to be in a dark room by myself with no sound. I'm sorry if this sounds bitter, but I go through this every couple of months when I have a really bad headache, nine times out of ten they have to admit me and the doctor says that the easiest way for me to be admitted is through the ED. I don't show up there just to be annoying, I'd really like to not have a headache. I'd just like to have someone who understands what I am going through and can be nice to me when I am in so much pain and just need someone on my side

[MomNRN, BSN, RN]

It is quite obvious Sugar that you have never worked in an ER.

Also, if you would have read the first 43 pages, you would have realized that the initial point of this post was to VENT to other ER nurses who are on the front lines. It is not meant to be taken personally.

BTW, I have been known to ask the same question over. Sometimes I remember, sometimes I am too busy with people dying to remember what drug it is you may be allergic to. It is my job to ask the questions over.

You must have issues with previous ER care and that is unfortunate. Perhaps you could address your post to those nurses.

[CritterLover, BSN, RN]

i find that a lot of ed nurses are not very happy to be there, and to be honest if there weren't people coming in there every day there wouldn't be a need for ed nurses. my problem is the nurses who can't so much as give you a smile. anyone that goes to the ed does not want to be there... especially at 3 in the morning even if some of the nurses think they want to be. i know that i've gotten grumpy a. because i feel like i am an imposition on the nurse then they expect me to respect them when i'm not getting an respect either, it's not my fault that your having a bad day, i wouldn't be there if i wasn't having a bad day and i can treat you like a decent person. b. the nurse can't so much as smile, come on laughter is the best medicine and if you can smile and move on it makes both our lives much easier. c. most the time i'm in the ed it's for migraine headache (when my neurologist sends me there because there isn't anything they further they can do at their office and they know i need more help) if i have a headache could you please listen to me the first time i explain things to you, i know we're all human and forget things, but when i hear the same questions over and over again i get aggitated, i have a migraine i would like to be in a dark room by myself with no sound. i'm sorry if this sounds bitter, but i go through this every couple of months when i have a really bad headache, nine times out of ten they have to admit me and the doctor says that the easiest way for me to be admitted is through the ed. i don't show up there just to be annoying, i'd really like to not have a headache. i'd just like to have someone who understands what i am going through and can be nice to me when i am in so much pain and just need someone on my side

this is a bit off-topic, but i'm having a really hard time understanding why your doctor is sending you through the er when he knows you need to be admitted.

that is a horribly inefficient way of getting admitted.

not only that, but it causes to to get both an er bill and a bill from the er doc. this is in addition to your inpatient hospital bill. it also take control of the situation out of your doc's hands and puts it into the hands of the er doc, who may or may not agree that you need to be admitted.

it would be so much easier (and cheaper, and quicker) for him to write direct admit orders, have office staff call the hospital to get you a bed, and send you on over.

the only time direct admits go through the er here is if the hospital is full and there are no beds available. otherwise, straight to their room they go.

[JessicRN]

I find that a lot of ED nurses are not very happy to be there, and to be honest if there weren't people coming in there every day there wouldn't be a need for ED nurses. My problem is the nurses who can't so much as give you a smile. Anyone that goes to the ED does not want to be there... especially at 3 in the morning even if some of the nurses think they want to be. I know that I've gotten grumpy A. because I feel like I am an imposition on the nurse then they expect me to respect them when I'm not getting an respect either, it's not my fault that your having a bad day, I wouldn't be there if I wasn't having a bad day and I can treat you like a decent person. B. The nurse can't so much as smile, come on laughter is the best medicine and if you can smile and move on it makes both our lives much easier. C. Most the time I'm in the ED it's for Migraine headache (when my neurologist sends me there because there isn't anything they further they can do at their office and they know I need more help) if I have a headache could you please listen to me the first time I explain things to you, I know we're all human and forget things, but when I hear the same questions over and over again I get aggitated, I have a migraine I would like to be in a dark room by myself with no sound. I'm sorry if this sounds bitter, but I go through this every couple of months when I have a really bad headache, nine times out of ten they have to admit me and the doctor says that the easiest way for me to be admitted is through the ED. I don't show up there just to be annoying, I'd really like to not have a headache. I'd just like to have someone who understands what I am going through and can be nice to me when I am in so much pain and just need someone on my side

you are welcome you can PM me anytime if you wish. Being a student is tough

[tvccrn, ASN, RN]

I have a migraine I would like to be in a dark room by myself with no sound.

Then why bother to go to the ER. If this is all you want you can get that at home for free.

tvccrn

[canoehead, BSN, RN]

Sugar- I love it when patients come in with a list of allergies, meds, surgeries and other information that I have to ask. They don't have to repeat the whole thing five times. Some of the repeated questioning comes from knowing that people remember new meds and some pretty significant details if we ask them more than once. If you have it all written down there is less chance of you or I missing something important.

I agree with the other posters that the ER is a lousy way to access hospital services. Direct admit, or even prescribing IM meds for home use in certain circumstances would be easier on you.

[Altra, BSN, RN]

Most the time I'm in the ED it's for Migraine headache (when my neurologist sends me there because there isn't anything they further they can do at their office and they know I need more help) if I have a headache could you please listen to me the first time I explain things to you, I know we're all human and forget things, but when I hear the same questions over and over again I get aggitated, I have a migraine I would like to be in a dark room by myself with no sound. I'm sorry if this sounds bitter, but I go through this every couple of months when I have a really bad headache, nine times out of ten they have to admit me and the doctor says that the easiest way for me to be admitted is through the ED. I don't show up there just to be annoying, I'd really like to not have a headache. I'd just like to have someone who understands what I am going through and can be nice to me when I am in so much pain and just need someone on my side

Sugar9486, I'm going to share some information with you.

1. By my hospital's policy, I should be asking you if you have any allergies to medicine every single time I medicate you. Don't like it? Guess what ... it's not because I'm an evil ER nurse, it's because JCAHO dreamed this up.

2. There are not now, nor will there ever be, dark, private, quiet rooms in the ER in which you can be by yourself. That dark, private, quiet place you desire sounds suspiciously like ... home.

3. From what you've stated here, you are under the care of a neurologist who has not found a way to effectively treat your breakthrough migraines. When this happens, particularly at 3am, he/she directs you to the ER. I'm going to tell you why: because then you're not his/her problem until the following morning. By then, after he/she has had a good night's sleep and morning cup of coffee, he/she can deal with your case after the ER staff have attempted to make you comfortable and other docs have once again reanalyzed all your info, examined you, and written admission orders and gotten you admitted.

4. A question for you: have you found these repeated hospital admissions, complete with semi-private rooms, hustle & bustle activity, vital signs q 4 hours, repeatedly being asked to re-rate your pain ... helpful? Do you see a pattern here?

I would never allow my PCP or any specialist caring for me to direct me to the ER to be admitted unless I had a potentially life-threatening condition.