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.

[adrienurse, LPN]

PS, you should seriously consider finding yourself another neurologist if his idea of treatment and illness management is sending you to the ER. I'm just saying.

[canoehead, BSN, RN]

Rock on adriennurse!

...and I wish I could delete the NCLEX threads too- so it takes 2 days to get the results back, try testing over two days and waiting 2-3 months!

[adrienurse, LPN]

Yeah they should live in canada. I took mine in 98, it was on paper, lasted 4 hours and took me 6 weeks to get the results. As far as I know it hasn't changed.

[adrienurse, LPN]

:offtopic::offtopic::offtopic::offtopic::offtopic::offtopic:

Look evidently you have a lot of problems and I can see it's hard for you to live in pain but can this please be moved to it's own thread??? I mean come on Sugar. This discussion is not about you and you have completely hijacked it.

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

[MomNRN, BSN, RN]

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.

Beautifully said!

[Myxel67]

No wonder I hate going to the ER

[Sugar9486]

Once again.. this started out having absolutely nothing to do with me... SO I WILL RESTATE AGAIN 90% of people in here have said that they are sick of nasty grumpy patients, and ALL I SAID was if you would have a little compassion and maybe a smile on your face these patients might not be so grumpy and you might not be so stressed out and you might not this the ED is such a brutal place, but thats up to you. I know all of this from a nurses perspective and from a patients perspective and if you don't agree with me fine, quiet honestly I think that you guys take things WAY to seriously because it was just a tip.

Adrienenurse--- again you don't have to agree with me, and for future reference just becasue someones "profile" says nursing student, that doesn't mean anything... but believe what you like... and my neurologist is one of the best in the state, I have chonic severe pain and have for a over a year, some times it takes a trial and error process in order to figure out what works and what doesn't, if we knew what caused my migrianes this would not be as much as an issue... but again that was not what I wanted to say, I don't care to post about my migraines because I sound like a 10 year old complaining about cleaning his room, I was just trying to show you the perspective of the patient

For everyone else the question was never whether ED nurses are good at what they do, nor did I was to start an uproar, I simply said put a smile on your face... first of all you'll live longer, and patients react much better to it. I've had the nights when every patient is nasty and complaining about everything, I've been there, but I try to remember that I'm able to be above that and I keep a smile on my face and I don't let the little stuff bug me. Yeah there are reasons that people are not happy that are caused outside of work and some nights people just have a Bad night, thats life but what I'm saying is, if you try to smile through it you will feel a little better an your patients will react to you better. Now lets stop talking about this, this isn't where I wanted it to go, I was just trying to shed some light as to why patients are so ummanageable sometimes... a lot of times it's a reflection of the nurse, others people are just plain mean, and you can get over that too. Good luck to all of you, I'm sorry if I offended you thats not what I was going for, just trying to give you a different outlook! Have a great day!! :D :D

[Sugar9486]

As for rules of the ED, if you come in feeling like you are going to vomit at one in the morning, don't sit in the waiting room and make out with your wife, it's gross

[canoehead, BSN, RN]

Ewwww, I often wonder how people can kiss after one of them has puked. I think a 24h cease fire is in order whenever someone horks.

[LeahJet, ASN, RN]

No wonder I hate going to the ER

Yes, you would think that anyone would hate going to the ER.

But you would be surprised. I think it is a hobby for some.

[LeahJet, ASN, RN]

Sugar, bless your heart.....

It's not that we don't understand you. You have made your point ad nauseum. We get it, OK?

You seem like a very sweet girl and I am sure you will get our point one day too.:)

[TrudyRN]

1. 5. do not ask me "are you going to keep me?" as i am bringing you back from the waiting room. i don't have xray vision, i am not able to analyze your blood through your skin with my eyes, and i can't read the doctors' minds. maybe you could inform the pt before he asks you. people who don't work the er might not understand the place the way you do. he's just wanting to know, that's all. why get all upset if he asks if he's being admitted?

6. i can't help it that the doctor's office told you to come to the er to get your tests done because it would be quicker than having them done as an outpatient. they were wrong. (besides, they were talking about the lenght of time to get tests results, not the length of time you would have to wait in the waiting room.)

7. i am sorry that your doctor sent you here to have xyz test done. however, your doctor doesn't work here, and the doctor that does work here doesn't think the test is necessary. next time, have your doctor give you an rx for the test, and send you to an outpatient diagnostic center. you guys need to have your manager inform doc's offices to stop sending people to the er and just have them give out the prescriptions you mention. education and communication are key here. and apparently they need to be reminded often, not just once. the pts are just following doc's orders so you shouldn't take out your frustation on them. instead, why not try to nip it in the bud?

11. if a joint has been dislocated, kindly hold still while we get xrays and i start your iv. if you won't hold still, i will calmly tell you to call me when you have decided that you have hurt long enough and would like your joint fixed. the doctor can't do anything without xrays, and trust me, you don't wan't him to do anything without an iv

have you ever had a dislocated joint or a fractured limb x-rayed? it is extremely painful. i hope you might keep that in mind next time you need someone to hold still. have they gotten any pain med? is there someone trying to help them, not just demand that they hold still? i know you're busy but you just sound so cold that it made me wonder if you've ever had pain like that.