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.

[TrudyRN]

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...

why keep working there, though, if it is so hard for you?

[NicoleRN07, RN]

all of this is so true....i'm gonna add to it:

1. if you are sick enough to be in the er, there's no reason you should be talking on your cell phone while i'm trying to take care of you.

2. just because you came in by ambulance doesn't convince me that the toothache you've had for a week is an emergency at 3am.

3. no, i will not just give you a work excuse.

4. if your mom is my patient, do not call me every 5 minutes to see how she is doing....in the event that she really is sick...how will i be able to take care of her if i'm spending all my time on the phone with you. if you were that concerned, you'd be here.

5. it is not my responsibility to provide you transportation home, you got here, you can get home....and no i can not call an ambulance to take you home.

6. do not ask me if you're going to be discharged before you have to be at work, i do not know, and i do not care. it wasn't my idea for you to come to the er in the first place.

7. yes, the iv stick hurts a little, but it's not gonna hurt me at all.

8. if your blood sugar is over 1000, no, you can not have a pepsi.

9. you can not be having pain 10 of 10 on the pain scale, i just had to wake you up to stimulate your breathing.

10. if you see me running down the hall, do not stop me and ask me for a warm blanket, i don't run for fun.....chances are someone is dying!!

11. i know you've been here for 3 hours, but i didn't ask you to come.

wow.....i can't tell you how many times i've wanted to say those things!!!

[canoehead, BSN, RN]

:smilecoffeecup:

Yes, the IV stick hurts a little, but it's not gonna hurt me at all.

OMG, you are going to get it! You uncompassionate, self centered, uncaring nurse. Wait til I tell...

People, this is a venting forum, please

Respect the vent

or you will get a 14G IV, a 20Foley, and a broken call bell :pumpiron:

[TrudyRN]

Ha Ha Ha, welcome to the drive-thru society. Humm, a thought. Fleeting. Drive thru doc, present the problem, give blood, sit in your car quietly, receive results, go home. Wont work, no one to whine to during the wait.

It sounds brilliant to me. And hospital administrators will love it, too, because they could CHARGE FOR PARKING while they wait.!!! And the nurses should absolutely love it because they won't actually have to deal with patients.

[TrudyRN]

If your mother is a patient and we ask her a question, let her answer it.

YES

When the doc says "the nurse will discharge you in just a few minutes" they don't take into account that we need to wait for them to dictate, write discharge orders, get the equipment or meds ready, and do a final assessment, before you can actually leave the room. They definitely can't predict that ambulance arrival in the middle of the process. Just because it takes longer than 15 minutes to get discharged doesn't mean you are being disrespected.

Why not educate your doctor? Tell him to tell the patient that the nurse will be with you as soon as possible, probably within an hour, realistically speaking.

Or why not try to have a dedicated discharge nurse handle the discharges? It might still take a while but at least the original nurse won't have to deal with it.

[canoehead, BSN, RN]

You need to stop working in the ER, Leahjet. I'd be afraid to have you for my nurse and I'd be at Admin's ear in a heartbeat about your truly horrible attitude.

Having been in administration I have to say we actually encouraged attitude in our ER nurses. If they didn't bust up giggling after an explosive wet fart we could predict that they'd be in tears within 6 months. It was also well known during the Christmas party that the ER had the rowdiest table. You could either join in, or sit back and watch the show, but anyone that felt offended was encouraged to just look elsewhere (that was official policy from the DON). What is said and done behind closed doors (and in ER forums) is best not seen by the uninitiated.

[canoehead, BSN, RN]

Why not educate your doctor? Tell him to tell the patient that the nurse will be with you as soon as possible, probably within an hour, realistically speaking.

Or why not try to have a dedicated discharge nurse handle the discharges? It might still take a while but at least the original nurse won't have to deal with it.

1) The doc knows. They are the ones taking 30 minutes to dictate and write DC instructions. The nursing part actually does only take a few minutes.

2)We are already tight for staff, sometimes lifethreateningly so. We scramble to cover all the triages that come in. Getting a discharge nurse would take a wand and some pixie dust, to start with.

[TrudyRN]

1.

If you plan on committing suicide, do it right the first time. Oh and don't call 911!

I guess you have never been depressed. Or ever lost someone you love to suicide. How is it that you have such a hardness of heart? I'm sorry that life has made you so bitter and hope your life will improve to the point where you can begin to feel some compassion for your fellow man.

[Sugar9486]

Totally agree with that one... I dislocated my knee cap... my knee cap was just put back in place by the Othro doc an they tell me to keep still while they bend my knee around for x-rays.. right...

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.

[Sugar9486]

TrudyRN I think you totally have the right idea... I understand that working in an ER is hard work, and not like most others, but in nursing nothing is "easy" and nothing isn't just a difficult as any other field. Yes, ED nurses have to deal with the people that don't have to be there, but there is no need for the heartless things that some of them say.

I understand you want to vent which is fine, everyone needs that, but you go to and ED that isn't where you work and don't tell them that you are a nurse and see how you get treated... People in the ED are scared or in pain, a lot of times they just need someone to smile at them, and it eases their terror.

[EmerNurse, BSN, RN]

Oh I smile at my patients - and the more rotten and idiotic they are, the more I smile (maybe cause I know they'll be OUT of my ER soon?). But long about 4am, I'm having to pull that smile from wayyyyy down deep, specially after all the BS patients with a head cold who all out tell the ED doc they only want a note for work.

I've found that smiling and being very sweet really does help - but that does NOT mean that's how I'm feeling - just how I'm presenting myself to the patients, and I always have a good response. If I turn my back and grumble out of ear shot or come here and vent, I feel that's my prerogative.

Oh and as for the suicide comment. I believe the op of that post was referring to the gesture-queens (and kings) who have a fight with their SO and want some sympathy. 15 Tylenol and a charcoal cocktail later and they're singing a different tune. But sheesh, those folks are a pain in the butt while they're there. If you're not REALLY gonna kill yourself, then quit pretending, to get attention. You won't get much sympathy from me.

[adrienurse, LPN]

Gaaaaa!