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 Med Surg, ICU, Infection, Home Health, and LTC.

4.) if you feel like your going to vomit, please vomit in the trash can or the emesis basin that was given to you. not on the floor.

and not on me and my shoes!

New Rule #1: If you are a drug seeker, and you tell me that you are allergic to morphine, toradol, ibuprofen, and tylenol, but that you got this one drug once that started with a "d" --could it be, dilala? or--demolol? don't expect me to tell you the truth when i get you the stuff and you ask me how many many milligrams it is.

Corallary to New Rule #1: Telling me that the number of milligrams you got never works and that you need more immediately will make me very, very unlikely to believe that your pain is a 10.

Specializes in ER, Research.

WOW, I worked ER for 4 years, and it's like ya'll are taking the words right out of my brain...so true!

Specializes in Emergency.

I love this thread.

When I walk in the room and start to introduce myself and you cut me off to ask for a warm blanket and something to drink, you are at the very bottom of my priority list the rest of the time you are here.

When I am walking down the hall with both arms full of meds/tubing/pump, do not stop me to ask me to find out how much longer for pain meds, I don't know who your nurse is, I don't care, I am busy.

You will not eat or drink until I get all tests back, you can ask 7 times, you can use your call light, you will not starve, the answer is no.

No I will not numb you first for the IV. I don't even know how, because I have never done it, and I don't care. This is the emergency room, your problem should hurt more than and IV stick, if not, go home.

Syncope is not an emergency unless you are old or have a major medical problem. Drink some damn water and take a nap, I almost passed out on my way down the hall to check you in, suck it up.

Don't ask me "what do you think it could be" if I could give you a diagnosis I would have a F%$^(*&&^# MD at the end of name, and If you push me I will tell you it's likely cancer, a stroke, or a heart attack. And I don't have time to get into that.

Specializes in ICU,ER.
lillarn said:
New Rule #1: If you are a drug seeker, and you tell me that you are allergic to morphine, toradol, ibuprofen, and tylenol, but that you got this one drug once that started with a "d" --could it be, dilala? or--demolol? don't expect me to tell you the truth when i get you the stuff and you ask me how many many milligrams it is.

I can just see them pretending to "recall" the name of their DOC. If I wanted to see bad acting, I'd go to a Steven Seagal movie.

I guess it's the whole insult to my intelligence that gets to me.

Specializes in MICU.

:lol2:

Luving it! I volunteered in the ED for 1 month before I started nursing school and decided I really really didn't want to work there.

So, here's some post ER thoughts for you guys (so you don't think us inpatient nurses sell you out):

1) Don't complain to me about how long your wait was before you got your room. Trust me, I can tell that the ED didn't want to keep you any longer than they had to!

2) Don't complain about your ER nurse. By definition, I like her/him better than you. It's like the Fraternal Order of Nurses. This just makes me believe you will complain about me when you get out of the ICU to the floor. Why do I want to go out of my way for you?

3) If you can talk, then there is usually someone sicker (see original post) than you that I'm taking care of. I will not go outside where the smokers are to find your girlfriend.

4) Trust me, the ER nurse did you favor by not starting GoLytely while you were on a stretcher in the hall down in the ED. Now, drink it or my friend the 14fr NG tube will find it's way down your nose.

5) Too bad you got out of bed without calling for help to go get your stuff/play with the TV (how about using that remote I gave ya, huh?)/fix your sheet/etc and pulled out that IV the ED nurse put in. Because now I have to put in a new one and I'm not nearly as good as the ED nurse is. Sit down, this could take a while.

6) Every time you threaten that you will never come back to our ED or hospital, we all pray that you mean it. This is not a threat, it's a blessing.

7) If you threatened/abused/mistreated anybody in the ED, we will find out and then restrain you. We are good at it. We have lots of practice.

Thanks to you guys for being on the front line.

Specializes in Pediatrics.

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.

Specializes in ICU,ER.
schooldays said:
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.

Hmmm....this thread actually went 7 days before the "first one"....lol.

I am impressed.

?

Specializes in ICU,ER.
schooldays said:
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.

Well this ER worker hopes word of mouth prevails in the circles of the types we are venting about!

~making a cross with my two index fingers~ STAY AWAY!!

Specializes in ER, Peds, Charge RN.
LeahJet said:
Well this ER worker hopes word of mouth prevails in the circles of the types we are venting about!

~making a cross with my two index fingers~ STAY AWAY!!

My sentiments exactly!

Love this thread!

I don't work ER, I work cardiac, but I totally feel for you folks.

My additions:

If you berate the nurses, scream about needlesticks from phlebotomy, etc. you can bet that your IV will need changing and it will be a 16 or 18.

If you go to administration because it took the nurse 10 minutes to get you your darvocet, and you think it is because you are a minority, you can bet that we won't kiss your @$$ the rest of your stay and wait on you hand and foot.

If you tell us that you have sued this hospital once before, and you think it's a bad hospital, you can bet that will we chart every word you say verbatim.

If you have horrible chest pain, but "nitro doesn't ever work", you can bet you get three nitros every single time, and EKG, and call the Dr. before you get any morphine. Also, in this case we have very little sympathy for nitro headaches and tylenol is the remedy, not demerol.

If you point out the vein that you "normally use" and swear its a good one, I refuse to use it, just on principal.

If you threaten repeatedly to go AMA, and you are waiting for open heart surgery, I will soon get tired of trying to convince you to stay. Again, AMA paperwork is much simpler.

Just because the ER asked you a bunch of questions, this does not mean that I can "call the ER nurse" and get all the answers. I WILL ask them to you again, and I don't have time to listen to your griping.

Just because you demand a private room does not mean that we have one. Just because you SEE a private room open, does not mean that its not assigned or that I don't need it for someone really sick (see post one)

Just because your roommate is annoying doesn't mean I don't think you are too.

If you can't remember your own meds or take them correctly and you are an adult person who is not senile - why do you think that I am psychic and know what your "water pill" and your "blood thinner" are and the exact dose?

If I ask the question "so, who wipes you at home?" you know I am getting ticked off and you better do something for yourself if you intend on going home tomorrow.

If you want to complain because it took 5 sticks for us to get an IV in you - then why did you pull it out?

If your family calls the floor every 5 minutes checking on you, I won't have time to take care of you properly.

If you want me to mediate between you and your half-sister's husband, etc. and not allow them in the room - I am not Judge Judy. Work out your own problems.

If your refuse meds and procedures but still want to get well, then get out.

No, you cannot plug in your cell-phone charger right in front of the "turn your cell phones off, please" sign.

If your chest pain is a 10 and you are flipping channels and eating a big mac your family brought in - I am much less sympathetic.

If your senile mother in law is in the hospital and you are trying to get her to sign and make you power of attorney, I will not witness it.

I do not know how much each pill costs, and I have 500 more to give today. I know what they do, what their side effects are, and why you need them. End of story.

No, I will not give you a portable oxygen tank so you can go out and smoke.

I know all of this is not stuff anyone is taught in nursing school, and I truly do care about most patients. It is those few patients that you always remember though.

Good luck, everyone!

Specializes in NA, Stepdown, L&D, Trauma ICU, ER.
TazziRN said:
I wondered the same thing but didn't want to be the one to say it....

The banner under her sig kinda explains it, she's had lot of surgeries, starting at age 2 I think.