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, Infusion, peds, informatics.
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.

they wern't so bad before the saftey thing came about. when i lived in arizona, they really looked like butterfly needles with an iv catheter. now, though, that safety feature makes them impossible (for me, anyway) to use. i've never successfully stuck anyone with the thing, and have given up trying.

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!

i'm pretty sure that was what they used on my son.

thanks for the information.

erin

Specializes in ICU, Med/Surg, Ortho.

If this is your third trip to the hosp for GSW in two months, do not keep telling me how you are an innocent victim of circumstance - I don't care. If you want to die of lead poisoning it's your own business.

If you have a CHI, no you may not have heavy narcotics. I have to be able to assess your GCS. I'm sorry you hurt but this is my license.

If you have an ortho injury, no, I can't make the pain go completely away. Pain medicine works on nerve and muscle pain. Narcotics don't work well on bone pain.

Pain is a symptom NOT AN EMERGENCY!!! I'm sorry for your pain. I will treat it as fast as I can. But emergencies come first.

I have worked with people with life threatening illnesses. Trust me if you are concerned about the pain of an IV or lab stick - you are NOT sick (see OP's definition of sick).

To anyone who's ever said to a nurse "I'll have your job" - please, take it. Trust me you can't handle it.

On a side note, more and more I'm thinking this should be a closed forum. Apparently the title "allnurses" isn't a big enough hint to some people. It's frustrating to have to spend time defending ourselves to laypersons who haven't got a clue.

Stacie

The "butterfly" myth: I remember a while back I was reading in a magazine (probably the same one that said "Tell the triage person that you've had symptoms for X amount of hours no matter how long you've had the pain. You'll be seen faster"), that said, "If you are afraid of needle from a blood test, ask the lab to use a "butterfly" needle. You won't feel the pain."

ARGH! I betcha that caused a lot of headaches when the article came out.

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

This thread is so funny and great to read. I can't believe that it got so serious at one point. I am glad it's back and use it to laugh and smile after a trying day/evening in the ED. Trust me, I love being a nurse (it's my calling) but sometimes, I do wish that I could say to a patient:

"So you're 20 and you've had nausea and missed periods for 3 months and you really don't know what's wrong, right".

Or how about when a patient with multiple tatooes says, "I'm scared of needles!" Don't you want to smile and grin as you grab a 14 gauge.

But we don't do we, we smile and treat them as graciously, as calmly and more professionally then anyone involved in a service based industry. I really do love, love being a nurse.

On a side note, more and more I'm thinking this should be a closed forum. Apparently the title "allnurses" isn't a big enough hint to some people. It's frustrating to have to spend time defending ourselves to laypersons who haven't got a clue.

Stacie

Well there are some people that are laypeople that are understanding. Me for instance. I am not a nursing student or a nurse...I am just a person who has been in the hospital alot and being here really has helped me...I used to feel bad calling my nurse for anything but i came to realize that it would be the way i did it that would mean the difference between anoying her and not anoying them. I have really liked being a member here and would be very sad if i could not be a member anymore.

Specializes in ICU, Tele, Dialysis.

amen!!!allnurses should be all nurses!!!!

Specializes in Cardiac, Med-Surg, now in ED.

quik disclaimer: I have only worked in the ED for 8 wks. I do have almost 3 yrs experience on a telemetry floor. am currently unemployed. ED nursing is why I got into nursing in the first place, I love it. And I will be back in the ED.

DO NOT come into the ED with cc of "ODing in flexeril", "took 5 of granny's pills", then have mom come in and say it was 90. Deny any other drug use, be climbing the walls, hitting, cussing, spitting, biting, staff, throw mommy out of room, end up in 4 pt leathers while sister is saying "stop you're hurting her" (escorted out by security, claims assault), call me "mommy" and fellow RN "pumpkin", try to hump the RNs hand as you're being straight cathed for a UA, results lots of ETOH, marijuana and amphetamines in system, spend 14 hrs in a badly needed bed coming down, then refuse admit when a bed finally opens up, and tell us you don't need a psych cx.

Then have the gall to c/o bad service.

The next time you show up, 3 days later, same general cc, you won't be treated as nicely

Specializes in 6 years of ER fun, med/surg, blah, blah.
quik disclaimer: I have only worked in the ED for 8 wks. I do have almost 3 yrs experience on a telemetry floor. am currently unemployed. ED nursing is why I got into nursing in the first place, I love it. And I will be back in the ED.

DO NOT come into the ED with cc of "ODing in flexeril", "took 5 of granny's pills", then have mom come in and say it was 90. Deny any other drug use, be climbing the walls, hitting, cussing, spitting, biting, staff, throw mommy out of room, end up in 4 pt leathers while sister is saying "stop you're hurting her" (escorted out by security, claims assault), call me "mommy" and fellow RN "pumpkin", try to hump the RNs hand as you're being straight cathed for a UA, results lots of ETOH, marijuana and amphetamines in system, spend 14 hrs in a badly needed bed coming down, then refuse admit when a bed finally opens up, and tell us you don't need a psych cx.

Then have the gall to c/o bad service.

The next time you show up, 3 days later, same general cc, you won't be treated as nicely

AMEN!!!:yeahthat:

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.

I worked in a hospital where they also had these catheters. It took time to get use to but then I loved them. Total bloodless system with little to no risk of getting stuck. It is no different then using the butterfly's the plebotomists use. You did not have to fumble with IV extentions for saline locks as they were built in.

I miss them actually :o :o

These Are All Great Posts And As True Today As They Were 10 Years Ago When Exactly The Same Rules For The Er Were Published.

So At Least We Know The Trauma Continues On - Ours.

Specializes in acute care.

these are great