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.

[WDWpixieRN, RN]

As a retired dispatcher and clerk for a large sheriff's department and also a small P.D., and as most of the ED nurses on this forum can probably testify to -- those of you who are offended by ED nurse humor ought to hear cop humor...now THAT'S some sick stuff!!

What's the old saying? If we didn't laugh, we'd have to cry....I'm just a student (older), but I can't wait to be a part of this "sick society" called ED nursing!!

[AmandaBrittainy]

Oh, I know you just had a bad day and all, but I would take issue with #5. There is actually substantial disagreement within medicine whether the symptom of moderate fever in children should be treated with antipyretics. Furthermore, a child who already has a high fever is at very low risk for a febrile seizure. Febrile seizures most often occur when fever comes on quickly and spikes quickly-often before anyone even realizes the child's temperature is above normal. And lastly, febrile seizures rarely cause any lasting damage, other than scaring parents to death. I find it questionable whether children should routinely be medicated at the first sign of fever just to prevent them.

Again, I know you said you just had a bad day. But I also think all ER workers should remember that patients can and will vote with their feet based on word of mouth about ER experiences.

Explain that to the lay public while they are sitting in your ED doing a wallet biopsy if you do not treat thier childs 100.4 fever. Like we dont all know fevers can be beneficial.

[AmandaBrittainy]

I understand what you are saying, and if you told my post as telling you that you are a horrible person, then maybe I did not write how I meant to write. I know that there are people who are not sick in your eyes, and there are people who are not sick at all that come to the ER, but the fact is that regardless you have to treat them. I am not speaking about the nurses who treat every patient the same way... As I said before I have been to many hospitals in my area and many of the nurses are rude and nasty. I'm going into this field I know that a lot of times it's because they are over worked and under paid, but that is not the patients fault. My view is that maybe if nurses were more polite and kind to their patients maybe there would be more nurses in the field. I think that a lot of the nursing shortage is because people see how nurses act towards them, and they do not want to turn into that. The reason I am becoming a nurse is because I want to help people, I want to care for people, and I want to make a difference, I never would have become a nurse though if I had not met some of the nurses at one of the local hospitals where they strive to be polite and happy. It's a proven fact that when your nice, happy, and polite to people they get better faster, so for the people who sound angry and mean in their posts maybe you should rethink how you act.

ER nurses take a lot of crap, everyone knows this, and it takes a special person to be an ER nurse, you guys come on here and say some of the most hurtful and rude things and make me want to rethink my career choice... Think about the effect of your words to others... they do make a difference.

NurseErica- I'm glad that your one of the nice nurses out there, and I did not mean to offend you, but there are people on here that say things that should probably not be seen by everyone. When I'm a patient in the ER I try to be calm and easy going also, I know what emergency means, I've been trained to know what it means as have you. The people that come in thinking they are dying because they have a bad stomach ache haven't been trained to know what an emergency is and to them, they really do think it's an emergency. It's tough when your job has to revolve around something that can be someones opinion.

As for the fact that emergency rooms are for emergencies, this is true, I know that, but where I live at 2 in the morning when you have a severe migraine where are you suppose to go? We don't have urgent care facilities, the only option is the emergency room.

No you do not understand, there are now 300 less ERs in the country to date due to the abuse from the non-emergent and lack of funds. Now, more and more our patients who do have emergencies have less and less options and it will be getting worse for those who truly need even primary care for non-emergencies due to these problems and American society associating health care with anything other than accurate and timely treatment of thier medical problems.

[AmandaBrittainy]

Yes, I couldn't help noticing that the only people who protest these posts are non-nurses.

They keep saying "walk a mile in the patient's shoes." I wish more people would walk a mile in the nurses' shoes and see how it feels to be unappreciated and abused by the people you are trying to help. It would be easier to overlook if it was just one patient now and then. Then it might be easy to look at the patient and say "well, maybe he's having a bad day" or "well, maybe her parents didn't raise her right." But when it's multiple patients all day every day, it gets old.

Nothing summed up the validity of this entire forum more than these 2 posts. Does everyone think we went into nursing cause we wanted to sit around and complain about patients? No we are in this profession to treat illness, prevent death, manage pain and so forth - we have little patience for people that interfere with what we beleive to be important tasks in our line of work.

[caroladybelle, BSN, RN]

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.

It really doesn't matter how much pain is involved. Until those xrays are done and the patient properly assessed, in most cases, pain med will not be ordered by the MD.

This is not to be mean, it is not to dismiss pain, this is SOP in many facilities. And the nurse has no control over it. S/he is not "being mean", when this occurs.

And, yes, I have had pain and I have had fractures. It doesn't change the fact that certain things need to be done, to properly treat the patient. If one comes in with abdominal pain, use of certain meds can mask problems, interfere with diagnosis and seriously delay treatment.

[aberrn]

Wish I'd thought of this but it was an RT idea....

"Non compliant patients should be an automatic DNR"

[firstaiddave907]

I liked this post im not a nurse yet but it was informative and a little funney.

[schizo_maja]

do not walk up in my triage screaming on top of your lungs, criticizing me about how i triage kids, because, well... everyone will agree... i know who to take care first... yup, i know your kid has a history of seizure (because you told me 18 times already in the span of 15 minutes) but her complaint is ear pain for 2 days... i will take that boy who is actively bleeding due to massive laceration to his Left arm first... well unless your child will seize in front of me... NOW.

do not even ask where i did go to school, because I did. i can stand here and enumerate my qualifications as an RN, it won't take the whole night of course... OR... let me do all of us a favor and let me call the next one to be triaged and move on.

do not threaten to "bust my ass" (verbatim), i won't fight back, won't lose my job over you, but i will call the police have you arrested. we have monitors all over the triage area and i'll have a case against you. (i'm sorry, you don't want your 4year old child see you being taken away by NYPD)

it doesn't mean that if you/your child is brought in by ambulance that we will rush and go gaga over your soar croak (read: sore throat) for 5 days.

you are in the ED, not a restaurant. i gave you a sandwich already do not ask for 2 more, it is not my concern if you hadn't eaten in two days, you were here 15 minutes and will be out of the door after the methadone shot. i know you have your program, and we are not it, i can't give you your dose.

make up your mind!!! if you were born a certain year stick to it, do not give different year to different departments i send you(xray etc), believe me you will be here longer until we have a concrete evidence of your identity and the procedures done.

[JessicRN]

Do not swallow 50 of your antidepressants then immediately call an ambulance then come to the ED and refuse the charcoal and say you really didn't take any pills and just want to go home. You will get charcoal and it will be by mouth or by NG tube. You will have a complete workup medically and then you will have to be seen by psych. Screaming and yelling just buys you restraints :angryfire

[ERRNTraveler, RN]

My idea.... Distribute those dog-barking shock collars to family members/visitors in the ER. Everytime they stand in to doorway staring at you or come up to the desk to ask "how much longer?"..... ZAP!

Also... things NOT to say to your nurse:

-"You can only start my IV here" (points to tiny spider vein)

-"You only get one poke" (for blood draws, IV starts, etc)

-"If this doesn't go quicker, I'm going to leave" (this is not a threat, it's a blessing- you will be handed an AMA form & shown the door...)

[JessicRN]

please don't come to my triage and ask for a pregnacy test when your are obviously pregnant:uhoh3: (I happened last night 7 months pregnant and the pt said my friend thinks I am pregnant)

[Aggie RN, ADN]

Here's my own personal rule...

Don't ask questions you don't want to hear the answers to.

I've found this simple rule has really helped my B/P.

Here's an example... kid (19 year old) swallowed a butter knife. I started the IV, consent for endo, pain meds, got a blanket, and paged the chaplin per pt request. But I knew if I found out why he did it I would regret it.

The chaplin came out of the room clearly disturbed. "That boy has issues," he said. I was happy I didn't pry. :)