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.

[Pepperlady]

If you come to the ER with a foot injury, or any injury that requres you to remove your shoe/sock, could you try to make it a clean pair of socks on a clean foot. Do not ask me to trim your nails for you or to "rub" them while you wait for the doctor. Do not ask me to "pick the scab off" so you can see how things are doing.

[JessicRN]

If you come to the ED and have a minor problem not foot related but have not washed your feet in a decade please please do not remove your shoes.

[Footballnut]

As it says, long. I have not been able to read this thread entirely yet but I have been laughing so hard. I see there are some naysayers posting here. Gotta have a sense of humor to do this job and I guess we didn't keep to ourselves this time. I am truly tickled by what my patients do and I am amazed that I have a strategy for each and every situation that was posted here. I've been doing this waaaay too long.

[ThrowEdNurse, BSN, RN]

When you take four Tylenol in an "overdose attempt" because you are depressed that your boyfriend dumped you, then you immediately text message him to let him know of your "suicidal ideations" before you even put down the glass of water, do NOT be surprised that when you tell me you are allergic to pcn I ask you why you did not take pcn instead of tylenol. I consider this pt education.

[ThrowEdNurse, BSN, RN]

Oh, and don't try to kill yourself by taking 12 flagyl. This will make me laugh and offer you a beer. Then when the doctor orders charcoal with sorbitol I will really laugh.....hard. And make sure you are ambulatory.

[DebanamRN, MSN, RN]

How about the suicide "attempt" who left a note stating "tell the ER doctor this is what I took?", and immediately called EMS. Got locked up in the secure holding area.

How about my son who had a temp of 99, puked once, and has a sore throat? Guess what? He had to wait until 2pm the next day and go to the pediatrician, because I'm not going to drag his misserable body to the ER and listen to him whine at me for x hours. The nurse in the Pedi office was impressed because I gave him ibuprophen for his temp and didn't let it get outta control. And I was like this before I worked in the ER! Amazing!

[DTNURSE512]

How about coming to the ER for sympathy? If you want sympathy find the nearest Hallmark, you might find some there. Stupidity, negligence, laziness, inpatiences and non-compliance do not desevere sympathy. I find 97% of the patients I have cared for, fall into these categories.

[dcb20020]

Rules for the Peds ER (a humble doctor's post. . .I promise, I won't touch the syringe pump and I won't leave a dirty diaper!!)

• Don't think that you can get mad at me and simply sign out your sick child AMA. It doesn't quite work that way--you cannot take your child home to die of an asthma attack because you don't believe in "Western medicine."
  
• If you don't believe in "Western medicine", don't bring your kid to my ER.
  
• Don't think that signing your nonsick child out AMA means a hill of beans to me.
  
• Don't bother threatening me with who you're going to bring back here--not only am I from exactly the same place you are, I still live there.
  
• Do not and I MEAN do not call anyone on my staff a white *****, a p**a negra, or "that li'l f****t nurse." They sometimes go an entire 12 hour shift without eating, sitting or using the bathroom. They are incredibly highly trained individuals and I will not allow you to verbally abuse them. I will have you escorted out of my ED.
  
• Please dispense with the notion that catheterizing your baby for a urine test will result in his circumcision or her deflowering.
  
• Please discipline your child while in the ED. Please do not explain the bruise on my forearm with the phrase, "Oh, yeah, watch out. He's a kicker." Adam Vinatieri is a kicker. Your child is a brat.
  
• Don't come in the ED yelling about how you're going to retaliate against the people who beat up your 12-year-old daughter. . .in the alley. . .at 10 p.m. . .on a school night. . .while she was smoking weed. Seems to me you should be fired up about other things.
  
• Do not ask me how long it'll be before someone attends to your child's ear pain when you can clearly hear the wail of the mother of a newly dead child down the hall.
  
• Do not come into the ED demanding a psychiatric admission for your 17-year-old who won't listen to you even though you've only been back in his life for 9 months because you were on drugs for the 16 years and 3 months prior.
  
• Unless an arm/leg has fallen off or your child is a distinctly different color than usual, please make sure your child has had symptoms for at least an hour before arriving to my ED.
  
• Do not give your two year old hard candy while they're lying down and I'm looking in their ears.
  
• Please don't tell me about what your child won't let me do. ("Oh, he's not gonna let you look in his ears.") I don't know what you do at home, but I hadn't planned to ask his permission.
  
• When I ask you a question, answer it! Don't give an answer to the question you thought I should have asked. When I ask you, "How many times has your child vomited in the last 24 hours?", your answer should involve something resembling a number. Not, "Well, I think he got this from that other boy at his father's li'l fast girlfriend's house, I told him I didn't want her around him 'cause I think the child has crabs."
  
• Do not complain to management because we don't have Christmas presents for your child and his 3 siblings plus the one at home.
  
• Do not think that because your pediatrician has called ahead that you'll be taken in front of everyone else. This is not a Chinese carryout.
  
• Do not call ahead to get your neighbor's child into the ED faster; I don't care how high on the surgical food chain you are. Your friend's child will get triaged just like everyone else. And when asking if she should come here or go to another hospital, don't ask, "Well, how is our ER? Is it nice?" Well, that depends. By nice, do you mean will we keep at least 10 feet between her and anyone that is Black/poor/Latino/sick? We'll do our best.
  
• Please attempt to be sober when you bring your baby into the ED. If I go too long without talking to our Child Protection team, I start to get hives, so don't tempt me.
  
• Speaking of substances, do not bring your 19 year old into my pediatric ED with a chief complaint of, "He smoked some weed and now he's acting weird." My response to you will be a very unprofessional, "Well, he got his money's worth. . .or maybe your money's worth."
  
• Just because you can reproduce doesn't mean you should. (I would gladly give out Depo-Provera shots in the ED. Gladly.)
  

Oh, how I wish sometimes we could remove our ultra-professional demeanor and respond appropriately to the things people do and say. . .

[canoehead, BSN, RN]

dcb20020- I could hug you! Welcome to allnurses.

[AngelfireRN, MSN, RN, APRN]

dcb20020- I could hug you! Welcome to allnurses.

As a new NP, I'll second that. Wanna come work with me? Your outlook and mine together would make for a very good practice!

[EDis4me]

HAHA! I will be sure to remember all of these pearls of wisdom when starting my new grad ED job in June. This is way more helpful than a majority of stuff you learn in a nursing program.

[T123G123]

I just wanted to say I really enjoyed reading these "rules" comments and I am full of admiration for you for the type of crap you put up with and the fact you still care about your patients. I'm a teacher and about to go into nursing in 2 years and I understand the "mean humour" (as some have termed it).

After a week of having kids yell at you, misbehave, go crazy in the class on you; after getting 5 hours of sleep a night marking tests and planning lessons and assignments that over 50% won't do on time anyways when Friday night comes and you call up your girlfriend or buddies and talk about teaching, it ain't always to say nice things about your work.

Griping off the job makes a lot of sense to me, and I think it's awesome to be able to use humour and say what's really on your mind about the people you have to deal with who come to get help (or an education), suck everything out of you, and then complain that you aren't God and can't fix everything for them or let them get away with stuff that could end up with them being hurt and/or you being fired.

To people who are reading these comments and criticizing, I'm going to say that most of the people who wrote them are putting in EVERYTHING to serve their patients and this is their way of reacting to the crap that is often thrown on them. CHILL OUT!

If you are a patient, just use your common sense and don't complain about everything or give the nurses a hard time. Act like a human being and you won't need to be offended by the above comments, b/c they won't be about you.

For those who are not nurses and are condemning these people for saying what they said, if you don't do the work they do you don't understand. Granted, I'm not a nurse. I am a teacher, though, and I occasionally hear some know-it-alls complain about how teachers "don't care enough" or love to point out every little mistake we make.

Work five 14 to 15 hour days (you get paid for 7 hours, the other 8 you are planning lessons or marking tests), then come to work after 5 to 7 hours of sleep and be expected to ensure that Joey passes Science even though he hasn't done an assignment for over 6 months, keep your class of 33 hormone pumped teens from rioting and try to get them interested in world war one when all they know and care about is who Britney Spears slept with last time and how loud of a fart can Bobby make while you try to explain the hypagorean theorem (btw you teach 6 subjects in addition to coaching volleyball after school) and keep Allie and Dorothy from ripping out each othr's eyes over a boy after school who they are dating online. Then say teaching is an easy job and that teachers have no right to make "insensitive comments" when not working about the kids we see for 10 months before they graduate or drop out.

I'm not even a nurse but I can understand the frustration and the need to vent. And I don't condemn you for it.