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]

Don't come in my ER and hover over the person I am talking to at the desk. I will get up out of my chair and physically tap on the sign that plainly says. Please wait here for the nurse. Otherwise, if you don't I may say...louder than I need to......

Mr. Brown, your hemmorhoids have been bothering you for how long????

[canoehead, BSN, RN]

"Are you going to keep him?" is a question best saved for after the labs, Xrays, and MD assessment has been done. I don't know by looking 5 minutes after he gets here. Repeating the question Q15min doesn't make the answer come faster.

[ERrookieRN]

OH MY! If I didn't know better, I would think I wrote this post myself! Too funny. Needless to say, there are probably a million ER nurses that could have written this word for word. I agree and wish we could post this on the entrance to the ER! HAHA!

[KarafromPhilly]

"I need 4 of morphine and 25 of Benadryl. I will ask for the same in one hour."

You may ask for whatever you like in one hour, dork. Good luck to you.

[TraumaNurseRN]

Don't come to the ER for constipation and then crab about laying in a bed for a hour when the ER is full and high acuity takes precidence over your nonemergent crap....literally...lol

[TennNurse]

Don't come to the ER for constipation and then crab about laying in a bed for a hour when the ER is full and high acuity takes precidence over your nonemergent crap....literally...lol

Also, do not ride in the ambulance past 3 other hospitals to come clutter up my night with your diarrhea woes, which started about 6 hours after you took 2 LAXATIVES!!!!!!

When your discharge papers arrive, complete with "Discontinue laxatives" written on them, do not gripe at me that you should be admitted or at the very least treated to an ambulance ride back home because it is 0200 and you don't want to disturb your family and friends.

[cadyjayne]

I am completely aware that there are people that are in much more pain than I am, and are much sicker than me.

But when I come in at 5 in the morning with migraines, partial blindness, and excessive vomiting, PLEASE PLEASE PLEASE bring a bedpan before you make me sit in there until 9 in the morning. Don't make me try to flag you down without opening my mouth (to avoid YOU having to clean up) just to have a place to puke. Please. Also, if I've been vomiting for 5 hours straight, offer me a drink or SOMETHING. So that way, when I just give up and leave after hours of excruciating pain with no relief, I don't collapse from dehydration.

I'm just pretty sure my hospital is completely understaffed. But yeah... I'm still bitter about that one. So much so, that every time that happens now, I refuse to even go to the ER.

[Blee O'Myacin, BSN, RN]

I am completely aware that there are people that are in much more pain than I am, and are much sicker than me.

But when I come in at 5 in the morning with migraines, partial blindness, and excessive vomiting, PLEASE PLEASE PLEASE bring a bedpan before you make me sit in there until 9 in the morning. Don't make me try to flag you down without opening my mouth (to avoid YOU having to clean up) just to have a place to puke. Please. Also, if I've been vomiting for 5 hours straight, offer me a drink or SOMETHING. So that way, when I just give up and leave after hours of excruciating pain with no relief, I don't collapse from dehydration.

I'm just pretty sure my hospital is completely understaffed. But yeah... I'm still bitter about that one. So much so, that every time that happens now, I refuse to even go to the ER.

*sigh*

Sometimes I refuse to go to the ER too. Then I realize that I have to put on my big girl pants and go to work.

Vent thread. I'm just going to flat out say that while I am sorry that you had a bad experience, this is an inappropriate venue to air your grievance. You are not going to find what you are looking for here. No one is ashamed of themselves for perceived misdeeds by association.

We are all heartless and mean and should never have become nurses in the first place.

Blah-blah-blah....

[Altra, BSN, RN]

I am completely aware that there are people that are in much more pain than I am, and are much sicker than me.

But when I come in at 5 in the morning with migraines, partial blindness, and excessive vomiting, PLEASE PLEASE PLEASE bring a bedpan before you make me sit in there until 9 in the morning. Don't make me try to flag you down without opening my mouth (to avoid YOU having to clean up) just to have a place to puke. Please. Also, if I've been vomiting for 5 hours straight, offer me a drink or SOMETHING. So that way, when I just give up and leave after hours of excruciating pain with no relief, I don't collapse from dehydration.

I'm just pretty sure my hospital is completely understaffed. But yeah... I'm still bitter about that one. So much so, that every time that happens now, I refuse to even go to the ER.

Rule #1: I don't "make you sit there". It is simply medically appropriate and logical that you, having an exacerbation of an already diagnosed, chronic, non-life-threatening condition, wait while we deal with undiagnosed, potentially life-threatening symptoms. It is the nature of triage, the nature of an EMERGENCY DEPARTMENT, which by definition sees any and everything that crosses its doors on a completely unscheduled basis.

Rule #2: Logic again ... no, we don't put fluids or food in the belly of a patient who is actively vomiting.

Rule #3: If you now "refuse to even go to the ER" when you have a migraine CONGRATULATIONS. ERs are brightly lit, noisy, sometimes smelly, and about the closest thing there is to Hell on earth if you have a migraine. You've taken the first step towards working with your PCP and/or neurologist on what can be done to better deal with your symptoms.

[cadyjayne]

Wow.

Sorry...I didn't mean to push buttons.

I know ER nurses are under a lot of stress and have a lot of patients to deal with. I grew up with an ER nurse and spent a lot of my earlier years there. I realize that this was the wrong place to air my greivances, but I guess in a roundabout way I was simply trying to make a point that some patients that don't get attention at all maybe shouldn't be ignored. I also realize (as I stated) that the situation was not at all due to ER nurses simply by association, but by that hospital in general, which I never should have gone to in the first place. The whole reason I ended up here is because I was curious about ER nursing, and I guess I kinda bit myself in the butt with that one.

The situation was not explained properly and the biggest bother to me is that the partial blindness was a VERY new condition, so was the severity of the headache (migraine or not, we don't know) and I was very obviously dehydrated to the point of fainting and nothing was done about it, whether putting food in my belly or anything else. I'm sorry, but partial blindness in a college-age female out of nowhere is nothing to shrug off, from what I understand. Since no doctors have ever determined the cause of my headaches (which have only gotten worse, along with the blindness), they tell me when they get "that bad" to just go to the emergency room.

Again, I apologize. It was inappropriate. However, I am curious - would any of you see a young patient coming in suddenly blind in one eye as something that should be paid attention to? I know it isn't immediately life-threatening, but yeah.

[sweetsounds]

Add to it:

You know that you can actually BUY A PREGNANCY TEST at a store, instead of coming to the ER for one. You can use the money that you saved by not buying condoms.

I swear I saw pregnancy tests in the dollar store one time. What I wouldn't have given for a truckload! You know if EMS would carry them I bet a lot of very ill/vomiting-type(female) patients would refuse transport.Wouldn't that be great? That would only leave the ones whose suspected pregnancies manifest as oh say, chest pain or SOB.

[Ruby Vee, BSN]

wow.

sorry...i didn't mean to push buttons.

i know er nurses are under a lot of stress and have a lot of patients to deal with. i grew up with an er nurse and spent a lot of my earlier years there. i realize that this was the wrong place to air my greivances, but i guess in a roundabout way i was simply trying to make a point that some patients that don't get attention at all maybe shouldn't be ignored. i also realize (as i stated) that the situation was not at all due to er nurses simply by association, but by that hospital in general, which i never should have gone to in the first place. the whole reason i ended up here is because i was curious about er nursing, and i guess i kinda bit myself in the butt with that one.

the situation was not explained properly and the biggest bother to me is that the partial blindness was a very new condition, so was the severity of the headache (migraine or not, we don't know) and i was very obviously dehydrated to the point of fainting and nothing was done about it, whether putting food in my belly or anything else. i'm sorry, but partial blindness in a college-age female out of nowhere is nothing to shrug off, from what i understand. since no doctors have ever determined the cause of my headaches (which have only gotten worse, along with the blindness), they tell me when they get "that bad" to just go to the emergency room.

again, i apologize. it was inappropriate. however, i am curious - would any of you see a young patient coming in suddenly blind in one eye as something that should be paid attention to? i know it isn't immediately life-threatening, but yeah.

i'm not an er nurse, either. i've been an er patient, and i've had some experiences that i wouldn't wish on anyone. but that's not the point. the point is that this is a vent thread for er nurses, and it's not appropriate for you to come in here and step on it with either complaints or a plea for better understanding of their patients. i'm sure they udnerstand their patients just fine. so if you're not venting -- or laughing -- please, don't participate.