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.

[PeachyERNurse, BSN, RN]

One night, we had all hell breaking loose in the ER. We had 2 simultaneous acute MIs, an acute CVA that needed TPA, and only 2 docs on. The one doc was with the CVA, and the other was going back and forth between the MIs. I was taking care of one of the MIs when my other pt's daughter grabs me and says (in a really huffy voice) "Excuse me, but my mother hasn't been seen by a physician yet." I apologized and told her that we had 3 simultaneous emergencies going on and the doc would be with her mom ASAP. In the same nasty voice, she told me "You don't understand. My mother is really sick." Her mom had SOB x 1 week and was doing quite nicely on 2L O2. I looked at her and said "Well, unfortunately, these people are actively trying to die, and actively trying to die takes precedence over 'really sick'". I never heard another word from her.

OK for my ER rules - 1) You, your husband and your 4 children (none of whom speak English worth a damn) with mild coughs and congestion x 3 days have a COLD! I can't fix it. Go home, get Triaminic or Pediacare and wait for 10 days for it to go away. It's a lot cheaper than the $3000 ER bill you are going to get that you aren't going to pay anyway. (The kicker was that the kids had an appt at the pediatrician at 10 AM. They arrived in the ER at 3 AM because they didn't think the kids would make it until 10 AM. Really? You actually thought the kids would die before 10????)

When you tell me you leaving and never coming back, I'm thrilled. Could you take the obnoxious drunk, the drug seeker and the person with the razor burn who thinks they should be priority one with you? Please??

I really don't care how the beer bottle got stuck up your butt. I do care when you lie to me, so please don't tell me that you fell on it.

If you are going to tell me that you only had 2 drinks and you're blood alcohol level is over 300, will you please give me the name of your bartender? That's someone I need to befriend

When you are covered in tattoos and piercings, please don't cry when I come to start the IV and tell me that you are afraid of needles. It strikes me as insincere.

If you have N/V or abd pain and you can pass the "Coke and Cheetos" test, you are not that sick and you can leave now.

LMAO!!!:roll

[linzz]

I have only used emergency two times, once, I was in labour, the other time, my son who was one at the time, asthmatic, was having trouble breathing in the middle of the night but only needed a masking. Now my family Dr. has had all patients sign an agreement that they will call her office before using the ED and then they will either see a Dr. or receive telephone direction on a course of action. If a patient decides to just go to the urgent care or ED for some non emergency without calling the primary Dr. first, they will be looking for a new family Dr which they likely won't find.

[andhow5, BSN, RN]

Here's another triaging vent:

If I'm in triage, don't come up to me, waving your finger in my face screaming I'm a stupid b*tch because I took someone back (with an O2 sat of 69 - and BLUE) that came in after you did (for your foot pain), and then stomp out the door (without difficulty on your 7 inch high-heeled slut pumps), because when you come back in 20 minutes later by ambulance I will smile sweetly and have the crew to turf you right back out to the waiting room.

Then we'll start your little game all over again, and I will be the winner!

And the more you scream, the sweeter I'll smile (and the longer your wait time will be...).

[ER/ONCRN]

WOW! This thread is so freaking funny.... I thought stoopid people only lived here! LMAOOO!!! OK here are mine:

DO NOT come into triage and tell me about the heart trouble your 3rd removed cousin has. I don't care!

You have a toothache? *** made THIS an emergency at 0350 in the morning??

After giving you an IM injection (exactly where YOU told me too), if you start to rub/massage the area, you will be labeled a druggie. Period.

NO You can't JUST have the Lortab filled on that prescription and not get your antibiotics. It's a package deal... all or none!

Do not come into MY ER faking a stroke. #1- my mother died as a complication after a stroke...this strikes home with me. #2- we have easy ways to determinie if your faking. If I hold your arm out and pretend to be looking for an IV site and let your arm go, it damn well better flail back to the stretcher! If you are able to hold it up, YOU ARE A FREAKING FAKER!

I cannot give medical advice over the phone. Don't call me when Aunt Sally's BP is up and what should you do? I can't tell you b/c she isnt in front of me for evaluation! Geeeesh

No, I will NOT be dispensing you a couple of doses of your narcotics just to take home. That's illegal and you arent worth me losing my license over. There is a 24 hr pharmacy 10 miles up the road.

If you come in c/o SOB, don't let me smell fresh cigarette smoke on you. You WILL wait in the lobby with everyone else!

OK sorry if any of these are repeats but I dont have the energy to read ALL of the previous 54 pages!

[tvccrn, ASN, RN]

I have only used emergency two times, once, I was in labour, the other time, my son who was one at the time, asthmatic, was having trouble breathing in the middle of the night but only needed a masking. Now my family Dr. has had all patients sign an agreement that they will call her office before using the ED and then they will either see a Dr. or receive telephone direction on a course of action. If a patient decides to just go to the urgent care or ED for some non emergency without calling the primary Dr. first, they will be looking for a new family Dr which they likely won't find.

That sounds like a good course of action provided your doctor doesn't mind getting the calls in the middle of the night from their service.

[canoehead, BSN, RN]

-"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...)

"OK, just let me know if you have to leave so we know where you are."

[linzz]

I should also mention that my family Dr. is part of a large group practice that take turns being on call. If, on the rare instance where there is no Dr. to take the call, then you are directed to a service called telehealth, which here in Canada is staffed by RN's. This doesn't completely stop all the wasteful trips to the ER, but it does stop a lot of them. Here in Ontario, Canada, some family Dr.'s are starting to go toward group practices. We are also seeing a lot more nurse practitioners which I think is great. Anyways, all of you ER nurses deserve tons of credit for providing great care while putting up with the nonsense that you do.

[MeganNY]

I had a fantastic nurse in the ER when I broke a rib. It seemed as if I were the only patient she had.

She was always there, asking about my pain, if I needed anything.

She was fantastic. I wanted to hug her, but it hurt too d*** bad!

I did write a note to compliment her to the nursing superviser of the ER; hope this lady received it.

Megan (former BSN student)

[JessicRN]

I should also mention that my family Dr. is part of a large group practice that take turns being on call. If, on the rare instance where there is no Dr. to take the call, then you are directed to a service called telehealth, which here in Canada is staffed by RN's. This doesn't completely stop all the wasteful trips to the ER, but it does stop a lot of them. Here in Ontario, Canada, some family Dr.'s are starting to go toward group practices. We are also seeing a lot more nurse practitioners which I think is great. Anyways, all of you ER nurses deserve tons of credit for providing great care while putting up with the nonsense that you do.

I like that In Montreal there were many CLSC's around that were opened late and kept many patients out of the ED. I do no understand here is there are several urgent care places the take walkins why do people not go there if they do not have an appt. Where my hospital is our hospital has several in the area and they take all the pt's we take yet still the patients come to us.

[48RVRN]

I've loved reading this! Here are some of mine:

1) Don't attempt to a hide crack pipe on your person just before a trauma CT series it WILL be found.

2) If you child comes in for febrile seizures for the 2nd time in 24 hours, and you say that you couldn't get any tylenol because you "couldn't afford it", and I see a pack of new smokes in your pocket, I will call Child Protective Services. Immediately. And no, you CAN'T leave AMA. Wave to the nice police officer.

3) If you have a child as a patient, and you are drunk you may NOT drive the child home. Don't ask. Don't even THINK about asking. Wave to the nice police officer.

4) You can call me any name in the book. But doing so might upset me and cause me to miss with this 18 ga IV cath. Then I'll have to try again. With a bigger needle.

4) You're allowed to be drunk OR stupid. Both earns you a Foley and a large-bore IV just before your CT....Where we find your crack pipe.

[dijaqrn]

If you come to the county urgent care clinic with chest pain since Saturday and it's Tuesday morning but you didn't go to the local hospital because of the bill; news flash....after your aspirin and IV you're going there anyway in a costly ACLS ambulance or via 911!!!!!!!!!!!!

We know that magazine or your neighbor said urgent care will see you quicker if you c/o chest pain; we want our friends the ER nurses to hear your story too.....

If you are having a heart attack or stroke go to the ER.....

and please send me a few of the fractures, strep throats, UTI's and earaches that we're able to deal with!!!! We need the business, I wish the local ER would just say no to these folks.

Do you know how much we appreciate you ER nurses???????

[littleRNthatcould]

This thread is so flipping funny..I love it!!! I have a few after an eventful weekend...

1. If you come in by ambulance at 2am for "lady partsl discharge" I am going to ask you about your sexual partners. It doesn't mean I think you are a "woman of loose morals"..It means I think you're an idiot for calling 911 for a yeast infection.

2. If I tell you that you need pelvic rest for several days to clear up your nether region woes and you respond with "uh-uh girl, I can't do that". Congratulations, now I DO think you're a skank AND an idiot!!!

3. When you have a BA of 291, are covered in your own vomit, urine and feces, this is not a good time to ask the nurses for thier home phone numbers or refer to them as "sweet cheeks" and refer to the size of thier breasts. This is THE fastest way to find your self in the pretty 4 point bracelets and sucking on a big fat breathing tube like a lollipop.

4.No, I will not call in a prescription for Xanax so you can be "chilled out enough to ride roller coasters." Having your "mom" call won't change my mind either.

5. If you bring in your 1 year old, pink, warm, happy, laughing daughter at 3am because she's "not sleeping" , please do not fill her bottle with Dr. Pepper right in front of me. It does things to my nervous system, makes me twitchy!!!

6. If I discharge said child without antibiotics, sleep aids, breathing treatments and your response is, "I'm not bringing her back here unless it's an Emergency" I AM going to laugh at you...a lot