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.

[TraumaNurseRN]

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.

Loved this one....and so agree.....(I'm sure others do as well.....except for the poster who protested so much..ha ha)

[moeluvrn]

Why not educate your doctor? Tell him to tell the patient that the nurse will be with you as soon as possible, probably within an hour, realistically speaking.

Or why not try to have a dedicated discharge nurse handle the discharges? It might still take a while but at least the original nurse won't have to deal with it.

ok, evidently, you've never worked in the ER, or any area that has a nursing shortage..most days/nights we are doing good to have enough nurses to take care of the patients..have a dedicated discharge nurse?? haha..thats funny.

[TraumaNurseRN]

WOW! I am not an ER nurse by any means...but I can definitely understand most of these "rules" but do you really not care about pain unless it is chest pain? I am a kidney stone sufferer, and while yes, I know I am not dying from this pain, at times I wish I would so I wouldn't have to feel it anymore. My last stone was 8 mm and I really thought I was gonna pass out from the intense pain, but luckily for me, my ER nurse valued my pain!

I think kidney stone pain is considered real pain and should be seen in the acute phase in the ER for IV pain meds and testing/treatment. It's not the legitimate pain we protest about. It's the chronic pain sufferers that use the ER as their primary physician to get their narcotics. The non-emergent patients who "choose" to be rude to us for our refusal to allow use of the ER as the concierge lounge at the Ritz Carlton.

I'm not sure why people have a hard time grasping that concept. I'm not sure even nurses who don't work in the ER could understand our vents about rules of the ER.

Isn't it quite interesting, that there is such agreement between ER nurses across the USA and elsewhere? How we've all experienced the abuse of the system so similarly, and how we vent similarly. But, I guess I would have to say that the non-medical person's ignorance about ER medicine is the same as well. They really have no clue....It can be frustrating to vent in a humerous way in a thread specific for ER nurses and deal with them questioning our compassion even when we're off duty and on a AllNurses.com website. Blows my mind

[33-weeker]

Originally Posted by schooldays

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.

BLAH-BLAH-BLAH!!!!!

Give your children tylenol if they have a fever for goodness sake. Also, Vote with your feet, walk them down to the next ER if you like as far as I'm concerned. If your child has a fever, treat the fever. If the child needs proper care, give proper care.....and I also say...blah blah blah...

Fever is one of the ways the body fights infection. If we reduce fever the minute it comes, we hinder the body in healing itself.

When my kids get a fever, I let them run it to a point. If its getting too high (starts to go above 102) or when they go to bed at night where I can't watch them like a hawk, then I give an antipyretic. They all do just fine with this plan. My kids have never had a febrile seizure.

[canoehead, BSN, RN]

Speaking for myself, I get frustrated when Tylenol isn't given for fever when it's the fever that brought the parent to the ER. So it was worrisome enough to come to the ER, but not so bad that they thought OTC meds were necessary. If the fever is high enough to come in at 3am, it's high enough to treat.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I'm glad to see this thread is still going on!! It makes me feel so much better to come here and vent, and to see that I'm not alone! I'm still not understanding why non medical people enjoy coming here to bash us, but whatever. Maybe someone will actually learn something from our vents and think twice before calling EMS for a sprained ankle.

I'm off to bed,..have to work tonight,.and guess what I'm in triage!! I'm sure I'll have some venting to do when I get done! Hope everyone has a great day!

[ThrowEdNurse, BSN, RN]

33-weeker, it sounds as though you have common sense. It also sounds as if you have a thermometer, the ability to use it appropriately, and antipyretics. Any references made to people not treating their child's fever appropriately in this VENT thread is a reference to people who have children and no thermometer, no pediatrician, no tylenol, and no sense. The reference made to people not treating fever is a reference to a fever that needs to be treated. As most of my pts diagnose fevers at home subjectively, without a thermometer, let's assume it is high enough to be treated. When many parents presenting make comments like,"I wanted to see how high it would get, I wanted you to see he really has one, and I didn't know what the doctor would want us to do (clearly the answer is cause brain damage)" it is really infuriating and my common sense tells me that this parent probably doesn't have the mental capacity to use common sense or let alone any sort of nursing judgement to determine if a fever is high enough to be treated. With some people you must break it down, educate as though they are 7 years old, and say things like, "Your child hot. Hot child bad. You give medicine. Your child no hot anymore. You get pediatrician now."

[ThrowEdNurse, BSN, RN]

Here's my ED rule:

Don't insinuate either prior to my IV attempt or during or after that I'd better get it, or that I am incompetent, or anything else that will add undue stress to the situation. It's common sense in my mind that everyone performs better when relaxed in any situation. If you say something ignorant along those lines you are pretty much guaranteeing a second stick accidentally if the pt has rotten veins (or intentionally if not:wink2:.) I don't know what you think your are trying to prove. Don't think that you threatening me makes me think you care about the pt otherwise you would have been there when EMS missed their 3 attempts, and you would have been there when I got it on the first attempt 6 hours ago, and you would have been there when I administered medications during the past 6 hours, and you would have been there when the confused pt pulled her IV out 30 minutes ago. You talking smack now just makes me MAD. When I am MAD, absent family members with big opinions get told, "You can obsolutely restart the IV if you want." Then they inevitably say, "that's not my job." And then I get to say, "Exactly, so you're going to need to calm down, back off, and let me do what I do every day proficiently and effectively without your opinion. You need to support the pt and not hinder my work. If this is a problem, you need to step out." I always win!!

[BrnEyedGirl, BSN, MSN, RN, APRN]

ThrowEDNurse Don't you often wonder why some of these people even bother to come to the ER? They start complaining at triage, the already know what's wrong and what needs to be done to fix it,.they know how to do our job better than we do,...so what do you need us for?

We've had a run of newborns with "high fevers" lately. I'm talking

It infuriates me when parents bring these little ones in who look fine, act fine, eating well, normal wet diapers, afebrile in triage and swear they had a temp an hour ago,.then act like we are cruel and mean when we have to put this baby through a full work up. This is an ER folks,.we treat emergencies. We take care of things that can't wait! That's why we're here, that's what we are trained to do and we do it! If you really didn't take that temp, if you really don't think your child is seriously ill, don't bring them to me to treat!

Arrgghhh ok,..off to work I go! Hope everyone has a great night! Send some happy thoughts to your fellow triage nurses tonight (me)!!!

[TraumaNurseRN]

33-weeker, it sounds as though you have common sense. It also sounds as if you have a thermometer, the ability to use it appropriately, and antipyretics. Any references made to people not treating their child's fever appropriately in this VENT thread is a reference to people who have children and no thermometer, no pediatrician, no tylenol, and no sense. The reference made to people not treating fever is a reference to a fever that needs to be treated. As most of my pts diagnose fevers at home subjectively, without a thermometer, let's assume it is high enough to be treated. When many parents presenting make comments like,"I wanted to see how high it would get, I wanted you to see he really has one, and I didn't know what the doctor would want us to do (clearly the answer is cause brain damage)" it is really infuriating and my common sense tells me that this parent probably doesn't have the mental capacity to use common sense or let alone any sort of nursing judgement to determine if a fever is high enough to be treated. With some people you must break it down, educate as though they are 7 years old, and say things like, "Your child hot. Hot child bad. You give medicine. Your child no hot anymore. You get pediatrician now."

I used to make information sheets to hand to parents upon a child's discharge, and was told not to go above a 4th graders learning ability as most of the parents that come to the Er with their children could not comprehend higher than 4th grade...Seriously...that's scarey!!!!

[TraumaNurseRN]

lololol...love it

[TraumaNurseRN]

I worked triage again tonight. argh!...anyway, there's a sign on a steel pole as you enter the triage area stating to wait there until the nurse is ready to see you. At one point I am getting the cheif complaint from a patient and when I look up I see 8 people not even 2 feet away. I said, has someone moved my sign? (Sarcasticly of course) They all look at me dumbfounded....I get up out of the chair.....and went to the sign and said oh, here iy is, can you all go read the sign and follow the directions for me. You are in violation of Hippa law and I wouldn't want it to happen again.

People just don't think....and how rude!!!!!:banghead: