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.

Specializes in ER,ICU,PEDS ER.

As we all know all of us real nurses love what we do, and always try to get better at it all of the time. This is such a work of art!!!!!!!!!!!!!!! BRAVO!!!! Encore!!!!!!! We also know that we had siad every one of these statements at one time or another, and they deserved being said at the time !!!! Thanks for the enjoyment I got from reading this..........:smilecoffeecup:

Specializes in Health Science Teacher, ER, MS, Home Hea.

I have a few:

-cover your mouth or turn your head when you cough or sneeze, I don't need your illness.

- Nausea for an hour is not an emergency

-most women who are pregnant have morning sickness, it's not something new!

- Your doctor telling you to come to the ED if you can't wait until the morning for an appointment is not a MD referral, it's you being impatient!

-Yes, I do know what I am doing, this IS necessary and NO I will not use a butterfly to give you fluids!

Specializes in Emergency.

-Yes, I do know what I am doing, this IS necessary and NO I will not use a butterfly to give you fluids!

If I had a dime for everytime I heard this one, I would NEVER have to work again.

Who out there puts "butterfly IV's" in? If I resort to anything less than a 20G, it is because I have already stuck the pt a couple of times and they have crap for veins.

I always have the same reply - "Sorry we don't stock butterfly IV's in our ED." The pts don't quite know what to think of this comment.

Specializes in ER.

i can't do crap with a butterfly, i miss every time. but a regular iv cath is no problem in 98% of cases. i just tell them i use the needle i'm most familiar with.

if you are sobbing for 45 minutes but haven't shed a single tear, for god's sake, pull out a nose hair or something so it at least looks realistic.

Specializes in ER, ICU, Infusion, peds, informatics.

the er waiting room is not a good place to pick up women.

especially when your cc is "hurts to pee" and her cc is "funny discharge."

can't we give the rocephin a chance to work????

Specializes in ER, ICU, Infusion, peds, informatics.
if i had a dime for everytime i heard this one, i would never have to work again.

who out there puts "butterfly iv's" in? if i resort to anything less than a 20g, it is because i have already stuck the pt a couple of times and they have crap for veins.

i always have the same reply - "sorry we don't stock butterfly iv's in our ed." the pts don't quite know what to think of this comment.

i have come to believe that the "butterfly myth" has been perpetuated by some lab people (i'm including all who draw blood for lab studies here -- phlebotomists, mas, nurses, etc) who can't stick worth a darn. after multiple attempts, then they say to the patient "i think you might need a butterfly." then when they finally get the blood, they reinforce the notion that a butterfly is neccessary to access that person's veins.

[color=#483d8b]

[color=#483d8b]the average patient doesn't understand the difference between a vp for an iv start and a vp for lab draws.

[color=#483d8b]

[color=#483d8b]the phrase irritates the living out of me, too. i just try to smile and say, "well, we don't have butterfly needles here, so we're just going to have to go with what we've got."

If I had a dime for everytime I heard this one, I would NEVER have to work again.

Who out there puts "butterfly IV's" in? If I resort to anything less than a 20G, it is because I have already stuck the pt a couple of times and they have crap for veins.

I always have the same reply - "Sorry we don't stock butterfly IV's in our ED." The pts don't quite know what to think of this comment.

:offtopic: I'm just a student so this is probably a dumb question, but when my son was 4 days old they had to start a IV and the IV needle looked like a butterfly needle (I have had a lot of blood taken w/ a butterfly needle so I'm pretty sure I know what one looks like). Was I just seeing things wrong or is there a butterfly IV that is used on babies?

Sorry for the off topic question, I was just curious. Now back to regularly scheduled program!:monkeydance: :thankya: I just love to hear everyone vent because I have a feeling that I will in your same shoes in a few years!!! So vent away!

ERin

Specializes in ER, ICU, Infusion, peds, informatics.
:offtopic: i'm just a student so this is probably a dumb question, but when my son was 4 days old they had to start a iv and the iv needle looked like a butterfly needle (i have had a lot of blood taken w/ a butterfly needle so i'm pretty sure i know what one looks like). was i just seeing things wrong or is there a butterfly iv that is used on babies?

sorry for the off topic question, i was just curious. now back to regularly scheduled program!:monkeydance: :thankya: i just love to hear everyone vent because i have a feeling that i will in your same shoes in a few years!!! so vent away!

erin

did it look something like this:

saftintima.jpg

these are iv catheters that are similar to butterfly needles, but have a soft catheter like an angiocath. i've never had any success with them, though i'm sure someone out there loves them. i saw them used quite a bit when i lived in arizona, but rarely since i moved to the south.

as canoehead said, it is best to go with whatever the person doing the sticking is comfortable with!

Specializes in ER.
Specializes in Emergency.
:offtopic: I'm just a student so this is probably a dumb question, but when my son was 4 days old they had to start a IV and the IV needle looked like a butterfly needle (I have had a lot of blood taken w/ a butterfly needle so I'm pretty sure I know what one looks like). Was I just seeing things wrong or is there a butterfly IV that is used on babies?

Sorry for the off topic question, I was just curious. Now back to regularly scheduled program!:monkeydance: :thankya: I just love to hear everyone vent because I have a feeling that I will in your same shoes in a few years!!! So vent away!

ERin

Erin -

I agree with what Critter Lover said. PLUS - there is a huge difference between a 4 day old baby and a whining adult!

Specializes in ED, ICU, PACU.
i have come to believe that the "butterfly myth" has been perpetuated by some lab people (i'm including all who draw blood for lab studies here -- phlebotomists, mas, nurses, etc) who can't stick worth a darn. after multiple attempts, then they say to the patient "i think you might need a butterfly." then when they finally get the blood, they reinforce the notion that a butterfly is neccessary to access that person's veins.

[color=#483d8b]

[color=#483d8b]the average patient doesn't understand the difference between a vp for an iv start and a vp for lab draws.

[color=#483d8b]

[color=#483d8b]the phrase irritates the living out of me, too. i just try to smile and say, "well, we don't have butterfly needles here, so we're just going to have to go with what we've got."

hey, we use a "butterfly" iv, the saf-t-intima----the most annoying, cumbersome thing you can imagine. took forever to learn how not to pull out the tip when having to pull out the needle and love how the end just flops around and twists/kinks no matter how well it is secured. really miss those angiocaths.

see for yourself

http://www.bd.com/safety/products/infusion/pdfs/saft_intima.pdf

Specializes in Emergency.
Hey, we use a "butterfly" IV, the Saf-T-Intima----the most annoying, cumbersome thing you can imagine. Took forever to learn how not to pull out the tip when having to pull out the needle and love how the end just flops around and twists/kinks no matter how well it is secured. Really miss those angiocaths.

See for yourself

http://www.bd.com/safety/products/infusion/pdfs/saft_intima.pdf

I checked out that website - they look very tiny and difficult to use. Do you use these on all pt's or just difficult sticks?

We went to the "wingless" IV catheters about 9 months ago. I miss my wings - it sure made it easier to use and secure.