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.

[Sugar9486]

Okay first of all being sent to the ER to be admitted to a floor is the way that they tend to do it, I have seen it done that way many times during the times I've spent in the ED an worked in a hospital.

Second I'm not talking about being asked about medications or allergies, I'm talking about things that are not JCAHO mandated. Like how are you feeling? Well I'm sitting here crying because I can't see straight and I feel like my head is going to explode, how do you think I feel?

Third I'm not asking for a dark quiet room in the ED, I know it doesn't happen, but if I weren't asked the same stupid things over and over again it would be much more quiet and you probably wouldn't get such a nasty reaction from me when I answer you for the fourth time.

Fourth my neurologist has never not come in to see me in the ED, he comes personally to see me instead of asking the oncall doctor to visit me.

I'm not sure what to say to number 5, but every time I am admitted I end up with a private room with curtains because the doctor has asked for me to be by myself. I am also asked to be left alone unless I need to be medicated. If I were not in serious pain I would not be there, I much rather stay at home, but when you can't see because your head hurts so bad and you've had a headache for 20+ days and everything you tried hasn't helped, yeah I need something else. I've been suffering with this issue for a long time now and don't think I'm not trying to figure out different ways to stop them from coming, but we just haven't figured it out yet.

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.

[caroladybelle, BSN, RN]

Okay first of all being sent to the ER to be admitted to a floor is the way that they tend to do it, I have seen it done that way many times during the times I've spent in the ED an worked in a hospital.

Second I'm not talking about being asked about medications or allergies, I'm talking about things that are not JCAHO mandated. Like how are you feeling? Well I'm sitting here crying because I can't see straight and I feel like my head is going to explode, how do you think I feel?

Third I'm not asking for a dark quiet room in the ED, I know it doesn't happen, but if I weren't asked the same stupid things over and over again it would be much more quiet and you probably wouldn't get such a nasty reaction from me when I answer you for the fourth time.

Fourth my neurologist has never not come in to see me in the ED, he comes personally to see me instead of asking the oncall doctor to visit me.

I'm not sure what to say to number 5, but every time I am admitted I end up with a private room with curtains because the doctor has asked for me to be by myself. I am also asked to be left alone unless I need to be medicated. If I were not in serious pain I would not be there, I much rather stay at home, but when you can't see because your head hurts so bad and you've had a headache for 20+ days and everything you tried hasn't helped, yeah I need something else. I've been suffering with this issue for a long time now and don't think I'm not trying to figure out different ways to stop them from coming, but we just haven't figured it out yet.

If this is how your MD does it, maybe you need to find a new one.

As an oncology nurse, the oncologists that are stellar rarely EVER want their patients going to the ER because they know that the care is not appropriate for their most of their regular patients...they take the time to direct admit if at all possible. Some patients do come through the ER but 75% get DA'd.

( no insult intended to ER - I don't work there - folk, but neutropenics do not belong down there, if possible. Not to mention, the leukemic in full blown blast crisis, w/WBCs of 80K, HCT of 27, that gets tranfused in the ER - let's just make a bad crisis much worse).

My MD has sent me to the ER twice - for rabies shots, and only because that was the only place in the area w/the vaccine. And secondly, for a CT scan post car accident - I had injuries on the CT.

Those "stupid things" over and over that you dislike. In the ER, if you present with a headache, one must presume and treat as though it could be ANYTHING - an aneurysm, possibly. They cannot assume that it is merely a headache. Some of those questions are REQUIRED to monitor your level of consciousness, and any changes. If something were to happen to you and the staff just "left you alone" as you wish, they would lose their license. Especially with a pain that has been going on so severely for 20+ days. The staff has to cover their bases. Your safety comes before your comfort.

You will also be asked questions repeatedly by different depts. It would be nice if they related to each other. This is a good comment to post to the PTB. But nursing rarely have control over that - if we did, it would not be happening.

If this is going on for 20+ days, it is not the ER you need but a new MD in that time or a pain control specialist, who can give you much better care.

[Sugar9486]

Do you think I haven't done all of these things, the fact is in the middle of the night at this hospital (that is magnet status by the way) the procedure is that you are admitted through the ED. Thats out of my control, and if I did not feel that I was getting adequate care then I would not be there period. The doctor I see is amazing and the only one who has taken steps in finding an answer to my problem. I have headaches 24 hours a day 7 days a week, I am never not in pain, usually once a month the pain picks up and becomes an actual migraine, every few months the medications I am on don't help, and I get admitted into the hospital. If I can wait until the next morning for relief then I wait until then and get directly admitted, if not then I am forced to go through the ED, my doctor nor me have any control over this. At the hospital I am at the departments do speak and work together, once on a floor I am never asked things twice the nurses are always cheerful and listen to the doctors order that I am not to be interupted unless I need to be medicated.

My doctor is not the issue, I have seen other specialists and they have pretty much told me that what I am doing is the way that I have to do it, I have no pattern with my headaches, I've kept diaries of daily activities, how I feel my stress is, my diet, I've done it all, I've tried around 10 preventative medications, many triptans, and lots of pain medications, the doctor is taking the correct approach to finding what combination is going to work for me. He is one of the top Neurologists in his field and does a wonderful job

Thats not what this whole thing was about what I was saying was if nurses in the ED had a little better outlook and maybe a cheerful smile patients might not be as grumpy or mean as they are, yes some of them still will be. I know that when I am treated by a nurse who is unhappy I'm much more likely to be uncooperative. If the nurse that helps me is nice and cheerful (even if she has a lot of other patients that may be more sick then I am) I am very cooperative and a much easier patient, I know a lot of people that feel the same way too.

I understand it's hard to be on your feet for 8-12 hours or more at work, I work in a hospital too, but I keep a smile on my face anyways

[Cattitude]

i just wanted to pop in on this thread and say from one nurse to another, those of you in the er do an amazing job.

don't worry about those that tell you otherwise. i don't believe for one second that they have ever worked in an er or are probably even a nurse to begin with. and if you haven't worked as a nurse, well you just cannot understand, you can't:nono:

no one can be suzy sunshine all the time, especially at 3 a.m., nope sorry. we're overworked, and overstressed. we do our best and most of us are compassionate, caring human beings.

so cut them some slack, bashers. and kudos to you er nurses.

i've only floated and that was enough for me! i think i would have had an mi myself if i had to work there all the time:uhoh3:

[Sugar9486]

Ok I have worked in and ED and I've work in other parts of the hospital, and maybe it's just my personality but I can keep a smile on my face all day long no matter what comes my way. I never said that ED nurses were not good at what they do or any of that and this turned into so much more then it started out as... Again all I said was if you can smile and be pleasant to the persona dying and to the drunk down the hall you'll like your job a whole lot more, and your patients will probably be much easier to deal with... Sorry if you don't agree with me thats fine, but I've noticed myself that this works and on days that I'm not in the greatest of spirits I find that I have a much bigger group of people who do not want to cooperate.

[LeahJet, ASN, RN]

Thanks CASgirl!

And Sugar, your point has been made and made and made. Thanks to you too.

[Sugar9486]

Apparently no one sees that my point has been made because things that had NOTHING to do with my point keep coming up, so yeah thats for the sarcasm

[RunnerRN, BSN, RN]

Ok I have worked in and ED and I've work in other parts of the hospital, and maybe it's just my personality but I can keep a smile on my face all day long no matter what comes my way. I never said that ED nurses were not good at what they do or any of that and this turned into so much more then it started out as... Again all I said was if you can smile and be pleasant to the persona dying and to the drunk down the hall you'll like your job a whole lot more, and your patients will probably be much easier to deal with... Sorry if you don't agree with me thats fine, but I've noticed myself that this works and on days that I'm not in the greatest of spirits I find that I have a much bigger group of people who do not want to cooperate.

I think we established a long time ago in this thread that "working in the ER" is not the same as "working as a nurse in the ER." You can keep a smile on your face when running a code on a kid? How about when that level I trauma's family gets there and sees their loved one on a vent with an OG and Foley? How about with the psych pt who really is seeing 6 other people in the room with him? And the drug seeker who is mean and nasty from the second he walks in the door? I am pleasant to everyone until they ask to be treated any differently. 90% of the time there is a smile on my face, but there are people who come in that I cannot smile with. I always say that it takes a lot for me to go from Happy and Friendly RunnerRN to Just Polite RunnerRN, but it happens, even for me.

I can appreciate what you are trying to get across, and think that it is a good point. Smiling and being upbeat does make the day better and faster. Not to mention how much more therapeutic it can be for people.

As a side note, I thought I knew the ER because I did my nursing school practicum there for 6 months, but you don't really know what it is like to be an ER RN until you are one, with full responsibility for your patients and your actions. You just can't.

[LeahJet, ASN, RN]

Another point is that sometimes you are considered "rude" if you are saying what someone doesn't want to hear. Smile or no smile.

I can be grinning like an idiot when I tell someone that we haven't diagnosed their chronic belly pain but that's not what they want to hear.

They leave not having their unrealistic expectations met and their overall attitude toward us is negative.

Let me add that I am not referring to anyone's specific experiences so please don't make it about that. Thanks.

[EmerNurse, BSN, RN]

Had a FF come in last night for the 11th time this month, 2 days after being d/c'd from the hospital. Comes in for the same thing every single time, NEVER gets his med scripts filled, CAN do it if he feels like it (soc. svc checked) - his comment? I HAVE A RIGHT TO COME HERE! Then covered himself up with a blanket and went to sleep. Thousands of dollars (yet again) for another work up, on our dime.j

Happy and bubbly? Nope. Polite - barely. Sometimes I'm just on the edge of losing my "nice". People like this really burn me up.

(and the FR who brought him in again - actually had the nerve to mention by name another FF we'd not seen in a few weeks. and THEN another unit did the same with another FF name. Guess we'll see them in the next day or two )

End rant.

[Cattitude]

ok i have worked in and ed and i've work in other parts of the hospital, and maybe it's just my personality but i can keep a smile on my face all day long no matter what comes my way. i never said that ed nurses were not good at what they do or any of that and this turned into so much more then it started out as... again all i said was if you can smile and be pleasant to the persona dying and to the drunk down the hall you'll like your job a whole lot more, and your patients will probably be much easier to deal with... sorry if you don't agree with me thats fine, but i've noticed myself that this works and on days that i'm not in the greatest of spirits i find that i have a much bigger group of people who do not want to cooperate.

i can empathize with your pain, i too have migraines, though certainly not as bad as yours.

please revisit this topic oh , about a year after you've been working as a nurse. i too worked all over the hospital in a different capacity before becoming an rn. it cannot ever compare. i find it offensive when people try. i'm sure that it's not people's intentions to offend but it's like making the statement "i feel what you feel even though i don't do close to what you do". it doesn't matter what position a person holds or even how close to being a nurse they think they are, it's just not the same.

add to it the added stress and specialty of the er, well that's a whole different game. i respect that...

[adrienurse, LPN]

Please please please be quiet and just unsubscribe from this thread. Yes you are a nursing student who knows what has been taught to you but the rest of us had the same training. We know that society is imperfect and that it has rights and that people fall through the cracks and that people don't like receiving service without a smile and kind word. Yes we know that. All of us. Nursing is a brutal job. People cope by getting jaded. We aren't given the chance to debrief at work cause there isn't time so we do it here. People who aren't allowed to get mad and complain crack up. Just accept that this thread exists and has a purpose and stop butting in. So you are tired of hearing nurses complain. I'm tired of seeing threads about NCLEX stress and meanie preceptors, but I'm not gonna deny anyone's right to have them.

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