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.

[MIA-RN]

If you come into the hospital complaining of stomach pain and we give you protonix and pepcid, you are not allowed to get angry that we didn't give you morphine. ESPECIALLY if your nurse catches you eating hot wings w/ bleu cheese that your wife snuck in. And please, have the courtesy to put the bones in the garbage, and not leave them on the floor.

If you are allergic to tylenol, aspirin, motrin, toradol, vicodin and percocet, and if morphine doesn't work for you...and you start asking for "what's that one...it begins with a d? Dilau...dila...dilaudid! Yes that's it! I always get 2 mgs of dilauded!"...honey, don't expect to get it from me.

If you are coming in to be seen because you've been nauseus for 2 hours you are not allowed to complain about the wait time. Ditto if you hurt your elbow last week and just decided to 'get it checked' even though it feels and looks just fine now.

If I ask you "What did your doctor say when you discussed it with him/her?" about the pain/symptom/whatever that you have had for the last 4/6/18 months..don't look at me like I am stupid. I am not the stupid one in this situation. Ditto when I ask you "What made it worse today?" Especially when its 10pm on a Tuesday and you have waited 8 hours to be seen for something that your doctor could have taken care of in the office in under 15 minutes.

And please, don't ask for a work note to cover the day you missed sitting here and the day you want to miss tomorrow. Please.

If you make a fist at me when I am trying to start your IV, you will find out just how fast security is around here. Same if you punch a doctor or threaten anyone.

No, you may not have a turkey sandwich until after the doctor sees you and says its okay. Yes, you told me you were vomiting all night and that now you're 'empty' but I am not feeding you until I know what's wrong with you.

No, the tylenol and motrin that we have here is not 'special' 'better' or 'stronger'. Its generic, same as you have at home. Seriously.

[33-weeker]

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."

In defense of those saying they wanted you to see that their child did in fact have a fever, I have done that, too (with my PC - not nec. the hospital ER) and brought a dose of OTC fever med with me to give the child as soon as they took the temp. I did this so they could document a fever and take me seriously that the kid is sick.

[33-weeker]

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:

Is your sign bi-lingual? LOL Maybe that's the problem. :chuckle

[Lurksalot, BSN, RN]

rule: Bring in a list of your 15+ medications... not all of the bottles in a trash bag with the labels worn off

rule: Don't come straight from your doctors office visit for a "second opinion" and then holler at the nurse because of the wait time to be brought back

rule, for visitors: when trying to get in the back to see your "loved one", please try to recall their full name. No, we can not knock on every door as ask for "pinky."

rule: if you climb into the sink and sit in it to clean your nether regions, do not be surprised that you end up in paper scrubs with all of your belongings locked up.

rule: when I ask you standard triage questions such as "Do you feel like hurting yourself or anyone else?", do not insist you will kill yourself if we do not give you something for your toe pain. That really, really is the wrong answer...really.

[ThrowEdNurse, BSN, RN]

When you are having a high drama crisis, it is in your best interest to respond to the sternal rub. All ED nurses can identify a high drama precipitated "unresponsive" pt. If you don't respond to the sternal rub you will get bilateral ammonia caps to the nostrils followed by the non-rebreather. Holding your breath will not help as I can stand here and watch you hold your breath all day, however you can only hold your breath for a few seconds. Do the math.

The coroner does not work for our hospital. If you have a problem with the fact that he elected not to do an autopsy on your 9000 yoa grandma with lung cancer, htn, dm, cad, and sz, feel free to contact the city and make them aware that you are willing to pay out of pocket for an elective autopsy. And yes, I will openly laugh in your face when you interrupt me in triage and demand to speak to the doctor listed on the death certificate. That's the coroner, derrr.....

When the pt is A&O and you have just showed up, don't ask me, "what the doctor said?" because I will look at you as though you are crazy. Have you asked the pt? And I have no idea what you are talking about, what, the weather? Yeah, Dr. Jones and I walked in together this morning and I said it looked like rain, he agreed. Then when you say, "No, what's wrong with him?" I'll say, "Uh, he's been here 10 mins and I am about to draw blood now. That's what the needle is for. All signs point to diagnostics not being done yet. But, since the pt said that this feels like GERD, I'm gonna go with GERD. You would know that if you bothered to ask the pt instead of wasting my time. NOW MOVE!!!"

The stop wasting my time goes with any question you ask more than once (ie: how much longer will it be?) and when all your family members call on the phone repeatedly to ask about pt status. HIPPA! Ever heard of it? You will probably wind up on eternal hold because it is rude to make me continually leave my pt's bedsides to answer your stupid questions. GET A LIFE!

VENT THREAD RULE:

If you don't like something someone has to say, just ignore it. No one wants to hear your personal life story, or how such and such isn't always true, or people should blah,blah,blah. Just stop! Thank you.

[Ruby Vee, BSN]

vent thread rule:

if you don't like something someone has to say, just ignore it. no one wants to hear your personal life story, or how such and such isn't always true, or people should blah,blah,blah. just stop! thank you.

amen to that!

[CrunchRN, ADN, RN]

VENT THREAD RULE:

If you don't like something someone has to say, just ignore it. No one wants to hear your personal life story, or how such and such isn't always true, or people should blah,blah,blah. Just stop! Thank you.

Absolutely!

[SMY2367]

If you are allergic to tylenol, aspirin, motrin, toradol, vicodin and percocet, and if morphine doesn't work for you...and you start asking for "what's that one...it begins with a d? Dilau...dila...dilaudid! Yes that's it! I always get 2 mgs of dilauded!"...honey, don't expect to get it from me.

Yeah, that one kills me. Or the "I need 4 of morphine and 25 of benadryl. I will ask for the same in one hour".

Don't come into triage eating a juicy cheeseburger c/o abdominal pain or not being able to keep anything down.

If I tell you there are no beds in the hospital and you will be staying overnight in the ER, don't ask me every hour if they found you a bed.

If you request to talk to the doctor, I will let him/her know. When they don't come in, don't take it out on me. I cannot drag them into the room. They will come when they come.

If you refused medication/diagnostic tests/blood draws, don't ask what's taking so long, why the doctor doesn't know whats wrong with you. Better yet, don't come in.

I've only been working in the ER for 3 months, so I don't want to sound so jaded so soon! Don't get me wrong, I still love what I do!

[I love my cat!]

VENT THREAD RULE:

If you don't like something someone has to say, just ignore it. No one wants to hear your personal life story, or how such and such isn't always true, or people should blah,blah,blah. Just stop! Thank you.

Right on!!

It's funny that you should mention this because on another thread where the OP was venting about a specific experience, I also pointed out how strange it was that others with different experiences, joined the thread to argue the original VENT. Then I get a response , something like this:::

"The way forums like this work is that a person starts a thread with their opening statement, then people respond with their own opinions or perspective. In this case, the OP stated rather emphatically that ................. (fill in the vent there).

Naturally, people might have a different POV and want to contribute that perspective here too, since this is an open forum and not limited to only one point of view."

Just can't win.

[TraumaNurseRN]

Vent all ya like, but I feel you shouldn't come in the ER nursing forum and talk nasty about ER nurses if you don't want claws to come out. It would be like me going into ICU forum and give them a piece of my mind about some issue I have with them. I don't do it, I wish others wouldn't in here.

[ThrowEdNurse, BSN, RN]

It's all about the little red x.....

[Virgo_RN, BSN, RN]

I am enjoying this thread immensely. Keep it coming!