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.

[lpnstudentin2010, LPN]

Like I tell my daughter "it's not what you say, but how you say iit" If you TELL me where to start your IV versus saying "most people have luck here" means a world of difference .

And I understand that, just wanted to put that point out there.

[MassED, BSN, RN]

Do people really order pizza, chinese food, etc? Which really gets confiscated and consumed by staff?

I've never been lucky enough to steal some ordered food from patients or visitors - never had that happen, darn! Don't you know ER nurses don't ever get to eat? sometimes food is ordered... then sits forever and you eat it 8 hours later when it's cold and hard. Yum.

[MassED, BSN, RN]

Not necessarily...I am allergic to pretty much anything besides fyntilal (sorry dont know how to spell it) I am allergic to morphine, dilaudid, and oxycodine so if i need a STRONG pain reliever I think that is the only one I can take. and i am NOT a nurse yet or a nursing student

that kinda makes the point of previous post.... I'm sure it's true for you, but when someone is "allergic" to all pain meds we use, one has to wonder.... that's just the honest ER nurse thought.

[MassED, BSN, RN]

the sponge that's used for birth control is *not* the same cello sponge you use for the dishes. that's why you can't get it out now.

yep, the idiot of the year award did this one a few years back! ... should've seen the thing when it came out!!

holy.........

:barf01:

[MassED, BSN, RN]

New Rule #1: If you are a drug seeker, and you tell me that you are allergic to morphine, toradol, ibuprofen, and tylenol, but that you got this one drug once that started with a "d" --could it be, dilala? or--demolol? don't expect me to tell you the truth when i get you the stuff and you ask me how many many milligrams it is.

Corallary to New Rule #1: Telling me that the number of milligrams you got never works and that you need more immediately will make me very, very unlikely to believe that your pain is a 10.

and you have to wonder if these addicts use the same stupid excuse in every ER - this is so common! How many mg? Do I get a few doses, cause it'll take more than a few of at least 2mg IV Dilaudid.... BS And they're the ones that tax us when the really sick ones are waiting while we deal with this crap.

[MassED, BSN, RN]

I think perhaps we should also remember that if it were not for our patients, we wouldn't have a job. I also think that some of you might feel somewhat different if you ended up being the patient in the ER. Sometimes, it is only a "gut feeling" of a parent that convinces them to rush to the ER with their child. Everybody...yes everybody that checks into the emergency room has an unmet need or they wouldn't be there. It's YOUR job to suck it up and do your job without whining and judging the human being that is there for care. If you don't like it,...then YOU go somewhere else. The hospital doesn't belong to just you, it belongs to the people...the homeless, the poor...the ignorant and the drug abuser and the alcoholic...the repeat offender...whatever.

rosieseattle, most ER nurses have dealt with all of this and we understand and are laughing about it to some extent - you have to. If it weren't for ER NURSES than where would patients go? We deal with so much crap on a daily basis that we are entitled to vent - in fact, it's healthy. The truly sick patients - we have their backs - the not sick ones are the ones that irritate us. If you can't understand the OP then you must not be an ER nurse. You have to laugh at some point at work or you will burn out and not be able to cope. Period. If it weren't for ER nurses, the patient's wouldn't have anywhere to go in an emergency - you are right about the gut feelings of parents and many ER nurses would not discount that - ever.

As for this comment of yours: " It's YOUR job to suck it up and do your job without whining and judging the human being that is there for care. If you don't like it,...then YOU go somewhere else." ----- as I wrote, the sick patients, truly sick ones, we have their back - all of that other crap gets in our way of doing our job effectively. But most go about it anyway without complaint, except here. So please, get over it.

[MassED, BSN, RN]

For the few people that have come into this discussion and insinuated that we are AWFUL people who shouldn't be allowed to live anymore.....WE ARE VENTING!! No, we do not say these things to our patients, and 99 times out of 100, I treat everyone the same. No, I won't be in the stable abd pain pt's room as much as the unstable GI bleed with no blood pressure, but all of my patient's immediate medical needs are met.

Until you train your ass off, learn how to care for 1000 different kinds of illnesses, and work in the ER for a time, you cannot begin to comprehend the crap we deal with. It is a chaotic atmosphere, and we must prioritize our time and energy. Wouldn't you rather I spend my energy on the sick sick (see post 1) patient rather than the non-sick abd pn patient? And yes, a lot of us CAN tell pretty quickly who is sick and who isn't.

I am not saying that the ER is "better" than anywhere else. Although to me, it is.....I could never work anywhere else in the hospital. It is impossible to describe what it is like to do compressions until you're sweaty and your arms are ready to fall off, call that code, then walk into another patient's room (not sick pt) and hear a bunch of complaints about how mother is cold/hungry/hasn't been to CT yet. The thing is, most people don't stop to think about the other things that may be going on....maybe mother hasn't been to CT yet because we were holding it for the 5 level 1 traumas that came in at the same time (happened to me last weekend).

Emergency rooms are for emergencies. Urgent cares are for urgent needs. The doctor's office is the place for that annoying arm pain that has been going on for 2 months. I wish people could walk 100 feet (it wouldn't even take a mile) in my shoes before calling me a "bad nurse". And yes, I have been on the opposite end (the pt) and I make it a point to be as calm and easy going as possible. Because, as long as I'm still breathing, there are people that are sicker than me.

and don't you just get so sick of having to explain to patients and their families that there are some traumas/codes (ie. other very sick people) and your CT or xray is being delayed a bit - the doc is in with the sick one, so can NOT come in RIGHT NOW to talk with you. Aghhhhhhhhhhhhhhghgghhgghghghghghghghghghg It gets to be mindboggling when you have to explain the concept of prioritizing EMERGENCIES to most patients - I mean, don't people understand that someone that is not breathing is a 'bit' more important than any other complaint (abd pain, knee pain, kidney stone...). WHY won't they understand?????!?!!!!!?!?!?!

[MassED, BSN, RN]

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.

you are in training, it appears - which would explain why you don't really understand the dark humor that is being vented here. It is necessary and healthy for OUR mental health as ER nurses. It is very much like a debriefing because the stress, grief, and horrible experiences has to go somewhere - I had a friend who used to say "put it in a bubble and blow it away" = well sometimes you can't do that and it goes inside, until you can let it out. You'll understand one day if you go to work in the ER - then come back to this post and update, please.

[I love my cat!]

21. If you tell me you have fibromyalgia or chronic

fatigue syndrome, know that I'm rolling my eyes and

thinking you're a loser.

Nicole R. Hayden RN, BSN

Really? I know that is suppose to be hilarious, but for some reason I find this somewhat disturbing.

[MassED, BSN, RN]

Really? I know that is suppose to be hilarious, but for some reason I find this somewhat disturbing.

underlying Depression or Anxiety (from what I have seen) is the common thinking, I can safely say - I don't know why it has to be equated to a Psychiatric problem, but it does... it's not fair, because I know there are physical symptoms that the medical community just doesn't understand.... Personally, I think looking into autoimmune problems is where patients should be investigating and pushing their docs to look into ... rather than assigning a broad and vague term to an illness.

[I love my cat!]

underlying Depression or Anxiety (from what I have seen) is the common thinking, I can safely say - I don't know why it has to be equated to a Psychiatric problem, but it does... it's not fair, because I know there are physical symptoms that the medical community just doesn't understand.... Personally, I think looking into autoimmune problems is where patients should be investigating and pushing their docs to look into ... rather than assigning a broad and vague term to an illness.

Actually, a Pain Management Specialist that I really respect (from UCLA) just returned from a seminar a few weeks ago and he told me that the direction of thought for Fibromyalgia is that it is a Neurological condition. He said that the most current research is finding that more people have the pain first and then the depression and anxiety follows, usually due to the uncontrolled pain or the fact that when some Medical Professionals continue to believe that it is Psych related.

I don't think we know nearly as much about the human brain as we think we do.

[Irish-RN]

Really? I know that is suppose to be hilarious, but for some reason I find this somewhat disturbing.

Disorders such as these should not be treated in the ER but by the patient's primary care physician!!!