Rules for the ER (long)

I know it is cynical, uncaring, and abrasive to say these things.... and I would never actually say them. I really do love my job, I just had a day where everything was wrong... I guess I'm just venting. Feel free to add to the list. Specialties Emergency Article

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.

Specializes in Retired OR nurse/Tissue bank technician.
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

Last time I had to pay a visit to the ER (suspected SJS), there was a young woman who was there to get a second opinion on a small (

I waited three hours in ER; she was still in the waiting room when I finally left. At one point just before I was called back she asked triage how long it would be...I wouldn't be surprised if she was still waiting 3 hours later, if not more.

Specializes in Retired OR nurse/Tissue bank technician.
to bad you cant just say the less favored docs when it is the greatest favored ones are on to weed out these people
I'm sure the front desk and triage would have loved to do that some days. They finally stopped giving the doctor's name out and told the people that if the person was that ill then they needed to come to the ER to be seen, regardless of which doctor was on.

Some would call because they were only going to come in if their doctor was working the ER-they used it as an extension of regular clinic hours. The ER nurses HATED when that happened and I don't blame them one bit; I don't think I would have been as gracious about it as they were. Coughs, colds and sore holes (falling on a shampoo bottle aside :p) are for clinic hours, not emergency rooms, even in small hosptials.

Honestly, though? I think at least some patients made the call because they figured out that there were a few doctors that really should not have been working in the ER and whose skill, or lack thereof, was downright scary. If those not so good docs were in the ER, the patient would go to the next ER 20 minutes or so away, take their chances staying at home (which could be deadly if they were having an MI/CVA or other major problem)or calling their GP for a non-emergent problem rather than risk dealing with the bad MDs (one way to stop the hangnails, bit tongues and nose pimples from coming in).

I once made the decision to travel to the next ER over (stupid idea, since I was SOB and starting to feel like blacking out) rather than be seen by the doctor that was working in the ER when I left work earlier that day.

It's so hard to do our job. But what's worse is people treating us so rude when you are only trying to do the best you can do and follow policy. Here I was finding her sick father a room really quickly (while 6 others waited).....I mean I could have had him sit in triage just like everyone else, but I felt it better he not be exposed....

What's the saying? Give them an inch and they take a yard?

I'm sorry that this happened to you. I can see that you were trying to be so nice, doing them favors so he (not "they") would have to wait, and you were treated so rudely.

Specializes in ED/trauma.
Today I resolved to be a happy, shiney, wonderful triage nurse as that was where I was scheduled. Side note: Why weren't people HOME watching all the football on New Years Day?....we were really really busy. Anyway, about half way through the shift I get this older gentlemen trached, bloody evidence on the trach gauze with complaints of fever, 2 days post chemotherapy and history of throat CA. He's saturating at 100% on room air, denies SOB, or pain.... vitals are w/i N limits.

I essentially found him a room before others who arrived before him........ waiting to go back...All of which had an ESI of 3. But....I just didn't want him exposed to the others. Okay.....So I send someone to quick make the bed up for me of a recent dicharge.

As I'm wheeling him back I begin to recant the policy that has become so "canned" that every triage nurse uses it and we say it nicely. "Our policy is to allow one family member back and then after they are seen by the physician, 2 can go back" " It shouldn't......The daughter cuts me off and says, "We're all going back"....I finished my sentence saying It shouldn't take but 20 minutes and we'll get 2 back"....She says, "We're all going back, come on MOM!" .....I said, "I'm sorry, but our policy states......"

Again she insists all 3 go back....and I nicely repeat the "canned" policy. I use my badge to gain access to the ER and after entering I turn around and see 2 family members following me. I stop and say again.....the "canned policy......nicely.

The daughter states as she is burning a whole through my forehead, " I am his care-taker and this is his wife" I said I'm sorry .....but our policy states......blah blah blah blah blah...sheesh. (Note: I have had to repeat the policy 5 times)

The daughter comes back and leaves her mother....his wife out in triage.

I get him back to the room, explain to him that all of his clothes need to come off except his underwear and socks, and ask him if he needs help. The daughter demands, " Go get his wife like I wanted and she can undress him". By this time I'm am thinking in my head....Damn that Press Ganey.....yet instead, I stood up straight and said..., " I'll send his nurse into help right away" and left the room with my New Year's Resolution to just smile and let "family" of ER patients treat me like crap and just trudge on .....intact. It's amazing how nurses are treated.

It's so hard to do our job. But what's worse is people treating us so rude when you are only trying to do the best you can do and follow policy. Here I was finding her sick father a room really quickly (while 6 others waited).....I mean I could have had him sit in triage just like everyone else, but I felt it better he not be exposed....

and the daughter was so rude to me. I assessed him properly, I was nice and compassionate for his needs yet I get treated so rudely. I later asked about the daughter's attitude throughout her father's care and the nurse told me she continued the attitude with everyone else. This is a perfect example of, no matter what you do, how well you care for someone.....some people are just rude.

I personally want to say to them...Shame on you, I am only trying to help and you are being an orifice....but I don't....outloud anyway.....lol

at my place I would have had security put the daughter out, all I have to do is give the word. they don't even question it.:nono:

at my place I would have had security put the daughter out, all I have to do is give the word. they don't even question it.:nono:

I was able to handle it without security thankfully.

Got one to add: If you are going to fake a seizure...do it right....seriously at least pee in your pants and don't get caught casually lying down before you start convulsing. It's embarrassing...and to the kid that did it once on my career...it really makes your mom mad when she finds out you were faking. OOPS> LOL

Specializes in Psych.

So I was working the other night....

It was sooo busy. As soon as you got someone out of a bed they had a gurney or wheelchair with a usually vomiting individual in it right there waiting for a spot. Most of us had at least one IMC or ICU hold, I had two ICUs, one DKA, one vent and drips. Then the other two beds were regular, one SVT (became an ICU later) and one abdominal pain. Got rid of one of the ICUs and got another regular pt. A migraine. The abdominal pain would not stop complaining. No matter how nice and calm I was to her. Constantly hitting her call light. "Why hasn't the doctor seen me yet?" I explain about level of severity and life threatening conditions needing primary attention. "Well who says my condition isn't life threatening!" I really impressed myself with the level of tact and control I exhibited in dealing with this woman. Her vitals were perfectly stable. She had an IV, gotten her meds. I mean dang! What more do you want from me?! The way the rooms are situated she can see that I had some extremely sick patients. But its all whine and "what about me?!" Finally the doc wants to discharge her but I need to give pain meds to my poor neglected migraine who has been ever so patient while I tended to my ICUs and the miserable abdominal pain. I'm just about to give the meds when the abdominal pain starts screaming " I'm leaving right now! What a horrible hospital! You people don't know the first thing about customer service!" She yanks out her IV and now I have to scramble over to her, tape her up and get her out the door before I strangle her. I finally get back to my migraine pt and apologize for the commotion and the time it took me to give her meds. She was so incredibly sweet. Even in horrible pain she thanked me and said she admired how well I handled the commotion. She said she appreciated everything I did for her and wished that others could see how much good ER nurses do. Thank goodness for the occassional patient who truly appreciates you.

D

Specializes in ER!.

When you come to the ER, you do not get to handpick the MD who will see you. If you are sick enough to be here, you will not care who makes it go away.

If not, then there is a real handy system in place by which you can select a specific doctor, call ahead and schedule a time to be reserved just for you, and when you get there you will have that person's undivided attention. All of your previous problems, complaints, allergies, medicines, and procedures will be handily awaiting your arrival in a personalized little file with your actual name right on it.

This remarkable entity is known as a Primary Care Physician. Find one of your very own today.

Specializes in Emergency.

Yes, the 45 minute old baby with a blood sugar of 35 is more important than your ever so quickly resolving worst nausea and vomiting of your life (now that you can smell your neighbor's dinner tray).

I can't believe I even stopped when she flagged me down.

I am grateful to start a new job on Monday.

Specializes in ER.

I can't believe I even stopped when she flagged me down.

Famous last words...

:hlk:

Specializes in Emergency & Trauma/Adult ICU.

Rule #682

To the impatient mom who brings ambulatory teenage son (simultaneously laughing, texting, & listening to IPod) to the ER c/o sore throat, who indignantly states, "We have to wait with all these people? For a kid? Can't you get a kid who's sick in quickly?"

..........

The following will apply:

Yes, sick kids (and adults) will get attention promptly.

Yes, you will wait.

Have a seat, thanks.

:hlk:

rule #682

to the impatient mom who brings ambulatory teenage son (simultaneously laughing, texting, & listening to ipod) to the er c/o sore throat, who indignantly states, "we have to wait with all these people? for a kid? can't you get a kid who's sick in quickly?"

life threatening emergencies come first. we are not going to let someone die just to take care of a sore throat. the waiting room is that way.