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.

EmerNurse-- That is exactly what I'm talking about, if your smiling at me while your in the room, then I'm much more likely to be cooperative. I know that when you walk out of the room your probably talking about me, thats life. I try to be an easy patient, I don't ask for a thousand things, I don't let my SO ask for a million things for me because I know what it's like and quite honestly I don't need three hundred blankets or an extra pillow. What you do when you walk out of my room is your thing, I work in a hospital, I hear and particpate in the grumblings under peoples breath, but if you can smile in the room, even with the drunk who's wasting your time (from most of the drunks i've seen smiling isn't too hard, a lot of times their pretty funny) or smiling at the person who could have waited to see their PCP in the morning when your slammed with other important patients it makes your life a lot easier. I know that my life is much more balanced and smooth if I can be polite and smile. No you don't want to get walked all over, but you can have that "don't mess with me attitude" and still be a understanding. Thank you for understanding!

Specializes in Med/Surge, ER.

I, by all means, am not uncompassionate, self-centered, or an uncaring nurse. Just because I think things, does not mean that I say or would ever say them to a patient or family member. I do however know how to do my job and I feel that I do it well, and provide quality care to all my patients.....and always with a smile.

Specializes in Me Surge.
EmerNurse-- I work in a hospital, I hear and particpate in the grumblings under peoples breath,

You keep saying you work in a hospital. Where in the hospital do you work and what do you do (what is your job title)?

Specializes in Med-Surg.

Time out for a cooling off period and moderator review. Thanks.

Specializes in CCU, Geriatrics, Critical Care, Tele.

Thread Re-opened, please keep the conversation civil and no personal attacks.

Thread Re-opened, please keep the conversation civil and no personal attacks.

Thanks, I'm glad the thread re-opened. I love 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.

Our d/c instructions are computerized . . the doc just tells us what the diagnosis is and goes to dictate and we print out the instructions. They sign, I sign . . . out the door.

steph

Specializes in ED, PACU, OB, Education.

Okay, had to add my 2 cents worth. After 20 years of ER work, I finally had to call it quits and move off to another plane. But the ER is, was, and always will by my true love. I laughed so hard as some of these posts. I am sorry for those of you who can't understand where these ladies are coming from - the comradery of ER nurses is truly unique. We vent but we always do what needs to be done. We seethe at perceived wasted time and resources, but we won't deny you what you NEED, only maybe what you WANT.

The worst thing that ever happened to ER nursing in my opinon was the 0-10 pain scale. If you can sit calmly in your chair and tell me your pain is a 10, then start screaming like a banshee when the blood pressure cuff pumps up, you don't have a clue what pain at a level 10 is. If you think you can convince me that your menstral cramps are a 10, think again. When I say "on a 0-10 scale if 0 is no pain and at 10 you are passing out with pain" and you calmly inform me that your pain is a 10, please don't be astonished that I don't believe you.

Trust me, if you are honest with me about what you really want, I'll truly try my best to achieve it for you if it is possible. If you play games, I'm smart enough to figure it out, plus my ER nurse antenna is fully developed and I will see through you and I will lose all interest in helping you because I don't have time for mind games.

I'll be happy to do a pregnancy test for you. After I've dealt with all of the true emergencies first ... But by the time that happens, you'll wish you'd gone to Wal Mart and bought one yourself.

I know many ER nurses from many different hospitals. Some big hospitals, some small hospitals. I've worked in Level 1 Trauma Centers and in small ERs that didn't even staff doctors at night. It's the same the world over. No ER nurse ever begrudges space in her ER for someone in need of help. But we ALL get tired of the same people sucking up the resources for self inflicted illnesses and problems who refuse to follow instructions or make any effort to help themselves. We are all very aware of the cost of ER care and resent that some people float in and out of there at will, using it for a private clinic while we suffer our aches and pains until our next day off to go to our doctor.

And to those of you who demeaned the nurses on this forum for venting their frustrations, shame on you. The day is coming when these nurses won't be there. I shudder to think about what I will face when I need nursing care. I wish I could freeze some of these gals and thaw them out when I need them so I know I'll get good care. God Help Us when these ladies retire. Yes, one day you will be allowed to retire. I know, we all have that image in our brain of pushing our walkers around from stretcher to stretcher, standing up on the bars of it to do CPR, hanging little pockets from the rails for our stethoscopes, tylenol, lotion, and other supplies. But one day ....

So vent away. It relieves the stress and enables one to take a deep breath and jump back into the fray. I used to tell my husband that we stayed married because I vented to the girls I worked with. Now I believe that nurses venting to each other is what keeps them sane in an insane healthcare system. Keep up the good work!!!

for those of you that are unaware:

a real good way to cause conflict is to make assumptions about what the motivations of others are based on benign statements. please avoid doing this and stick to the subject at hand which i'll reiterate for you from the op:

said edvaleriern:

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....

Specializes in Emergency Room.
Okay, had to add my 2 cents worth. After 20 years of ER work, I finally had to call it quits and move off to another plane. But the ER is, was, and always will by my true love. I laughed so hard as some of these posts. I am sorry for those of you who can't understand where these ladies are coming from - the comradery of ER nurses is truly unique. We vent but we always do what needs to be done. We seethe at perceived wasted time and resources, but we won't deny you what you NEED, only maybe what you WANT.

The worst thing that ever happened to ER nursing in my opinon was the 0-10 pain scale. If you can sit calmly in your chair and tell me your pain is a 10, then start screaming like a banshee when the blood pressure cuff pumps up, you don't have a clue what pain at a level 10 is. If you think you can convince me that your menstral cramps are a 10, think again. When I say "on a 0-10 scale if 0 is no pain and at 10 you are passing out with pain" and you calmly inform me that your pain is a 10, please don't be astonished that I don't believe you.

Trust me, if you are honest with me about what you really want, I'll truly try my best to achieve it for you if it is possible. If you play games, I'm smart enough to figure it out, plus my ER nurse antenna is fully developed and I will see through you and I will lose all interest in helping you because I don't have time for mind games.

I'll be happy to do a pregnancy test for you. After I've dealt with all of the true emergencies first ... But by the time that happens, you'll wish you'd gone to Wal Mart and bought one yourself.

I know many ER nurses from many different hospitals. Some big hospitals, some small hospitals. I've worked in Level 1 Trauma Centers and in small ERs that didn't even staff doctors at night. It's the same the world over. No ER nurse ever begrudges space in her ER for someone in need of help. But we ALL get tired of the same people sucking up the resources for self inflicted illnesses and problems who refuse to follow instructions or make any effort to help themselves. We are all very aware of the cost of ER care and resent that some people float in and out of there at will, using it for a private clinic while we suffer our aches and pains until our next day off to go to our doctor.

And to those of you who demeaned the nurses on this forum for venting their frustrations, shame on you. The day is coming when these nurses won't be there. I shudder to think about what I will face when I need nursing care. I wish I could freeze some of these gals and thaw them out when I need them so I know I'll get good care. God Help Us when these ladies retire. Yes, one day you will be allowed to retire. I know, we all have that image in our brain of pushing our walkers around from stretcher to stretcher, standing up on the bars of it to do CPR, hanging little pockets from the rails for our stethoscopes, tylenol, lotion, and other supplies. But one day ....

So vent away. It relieves the stress and enables one to take a deep breath and jump back into the fray. I used to tell my husband that we stayed married because I vented to the girls I worked with. Now I believe that nurses venting to each other is what keeps them sane in an insane healthcare system. Keep up the good work!!!

Very well said! I think there are two big issues that make ED nurses seem "callous": 1) it takes a very specific nurse to function sucessfully in the ER. 2) All nurses spend time during school on the med surg floor and get a taste of what it takes and what goes on there. Very few nurses spend any time in the ER during schooling, or during their career and most floor nurses don't understand why things happen as they do. I really believe this is part of the "us vs them" issues that go on.

Not saying that one is inherently better than the other....well, to me, the ED is better FOR ME. I would love to be able to work in an ICU, but I'm just way too impatient to enjoy having 2 patients all day. I love the change in patients and acuity that happens moment by moment in my department.

Now we come to my new rules.....

a)No we don't dose narcotics by weight.

b)When I'm taking your stepson's BP, and you are on the phone, please refrain from saying "I can't talk about that right now. There's some woman in here "messiing" with Mikey." Then get off the phone and say "What? That's what you're doing, you're "messiing" with him." And then be surprised if I completely ignore you until you can sweeten your language with a little respect.

Let's keep this thread open so my husband (the poop phobe) doesn't have to hear any bitching about my work life!!!!

Specializes in Trauma, Teaching.
:smilecoffeecup:

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

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:

heh-heh-heh Or instead of a 20 Foley, 20 of Lasix and a broken call bell:smilecoffeecup:

'Nother rule: if you are going to refuse the breathalyser with the cops, coming to the ER for a medical clearance is not going to keep you out of jail. It will get you a lecture from the doc, from me, and hopefully your wife when you finally make it home.

My DC instructions for this guy: doc wrote "quit drinking. quit smoking."

I wrote "quit drinking

don't drink and drive

quit smoking

you'll live longer

so will the people around you"

"Nother rule: if you are going to refuse the breathalyser with the cops, coming to the ER for a medical clearance is not going to keep you out of jail."

OMG reminds me of a story my Mom told me (who worked in a small rural hospital near a busy highway *shudder*). It used to be against the law to collect blood alcohol levels if the person did not consent (or couldn't). So she had a few freqhent fliers that had learned the trick and would play possum when the docs and police were there and then used to wink at her. IMAGINE the gall.