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.

Probably been covered, but:

If you, or the person who brought you in is eating a snack or drinking coffee, there is no emergency.

Specializes in ER, ICU, PACU, Corrections, cardiac.

People do not recognize themselves as the culprits. On a unit I used to work on, the secretary came on the intercom and announced "for the rest and comfort of our patients visiting hours are now over. We ask that all visitors leave" Thirty minutes later, the visitors in one of my rooms mentioned it and asked if that meant them. I asked "are you a visitor?"

Specializes in ER, ICU, PACU, Corrections, cardiac.

I know this patient!! I took care of them last weekend!! lol

Specializes in ER, ICU, PACU, Corrections, cardiac.

"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"

Ever worked ER? If you have a fever, we will treat it.

One patients mother brought her baby in with a fever because she didn't know HOW to give it tylenol or suction it's nose. Another mother kept calling me to the room because she didn't think the syringe pump was working because she "couldn't see anything in the tubing." and let her other child pull all the clean sheets out of the cabinet and get tangled in the EKG wires.

Specializes in ER, ICU, PACU, Corrections, cardiac.
Altra said:
I also figured it would come to this ... someone would say, "that's just MEAN."

You have no idea ... you probably think it's the rare exception - the person who does not need to be in the ER and is impossibly demanding.

It is not the rare exception - it is the norm. Every single day, every single hour, mixed in the with truly sick.

Many people are intolerant of symptoms - aches & pains, dizziness, nausea, diarrhea, & 50 other myriad symptoms of random viruses & upsets that we all encounter now & then. But for what I'm now convinced is a significant number of people it is intolerable that "I DON'T FEEL WELL" and it is equally intolerable to have to take some responsibility to feel better -- i.e., take appropriate OTC meds, call a PCP and be willing to wait a day to be seen because there is no medical reason why you must be seen sooner.

No, no ... "I MUST BE MADE TO FEEL BETTER NOW." I'm dizzy, my back hurts, my foot hurts, my neck hurts, my belly hurts, I vomited twice ... and on and on and on.

And some of you tell me that I must consider this to be an emergency just as much as my patient in the next room who is a shade of gray normally seen only when I catch Casablanca on TBS.

Please.

One morning, 2 different patients in with N/V that started less than 2 hours previous. "I called in sick and they wanted a doctors excuse or I would have just stayed home". And "I've been feeling a little short of breath for a couple months. The doctor said I have COPD" (O2 sats=98% on RA and smokes a pack a day) A wife brings her husband in with "chest pain" at least twice a month so she can go shopping. Just drops him off and leaves. When he gets tired of lying there, he pulls his IV out, gets dressed and leaves. My patient who got his thumb caught in a press and pulled it off had his buddies who were bringing him in stop by MickeyD's and get him a burger because he knew he wouldn't be able to eat when they did surgery to sew his digit back on. On my feet, on the run, 12 hours a day trying to keep up with 3 different doctors and 4 different patients with no chance for a potty break let alone lunch leaves me feeling a little grouchy. Then to have someone call me "mean" because I vent about drug seekers and visitors with the "wants" just makes it worse.

We live in a "take a pill to feel better" society now. A place where instant gratification isn't fast enough. People want you to make them feel better without taking any responsibility for themselves and have no plans to change their way of life. People amaze me. I am new in ER but have worked critical care for my entire nursing career. In PACU, women would wake up crying in pain saying "my doctor said it wouldn't hurt!" to which I replied (to myself) "it didn't hurt HIM a bit" or "you let someone cut you open with a knife. . . it's gonna hurt!!" Or my favorite DKA pt arriving to the floor on an insulin drip "I need some phenergan and something to eat" then would get mad when a clear liquid diet was ordered. At this point, I'm too old to do something else and too young for retirement. But I keep my sense of humor at work and treat my patients right.

Specializes in ER, ICU, PACU, Corrections, cardiac.
justavolunteer said:
I realize that a lot of the 'rules' are written by people to let off steam & are not entirely serious. Wanna hear something really scary? An ER doc in my local paper had a serious list of ER do's and don'ts. One of the don'ts was "do not physically assault members of the staff". The fact they anyone even has to SAY that speaks volumes about our society.

Sometimes I don't wonder why there is a nursing shortage. The real wonder is that people still want to be nurses.

And, apparently, in Indiana there is NO law protecting nurses from assault! You can't hit a EMT or a Paramedic but go to town on a nurse!

Specializes in ER, ICU, PACU, Corrections, cardiac.
ZASHAGALKA said:

Of course. "Is there anything else I can do for you? I have the time."

~faith,

Timothy.

Sounds like you work at the same place I do. that's an exact quote! Are you Magnet? We're applying in June

Specializes in Trauma, Teaching.
CathiP said:
And, apparently, in Indiana there is NO law protecting nurses from assault! You can't hit a EMT or a Paramedic but go to town on a nurse!

Come to New Mexico, its a FELONY here!

Assuming you can get the cops to arrest them.....

Rule number 8763: (also number 1!) Do not hit me. After I pick you up off the floor where you fell after accidently hitting your head on the cabinet, I will call the police.

Specializes in ER, ICU, PACU, Corrections, cardiac.
cadyjayne said:
Wow.

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.

Partial blindness with a migraine is an "aura". I get them before my migraines all the time. Migraines usually caused by stress or weather changes. In my younger days, I tried just about every (non-narcotic) drug there is. Learned to suck it up, go to bed with an ice pack in a dark, quiet room. Have worked with more of them than I care to count. Probably because I just LOVE to work sicker than most of my patients!

Specializes in ED only.

21. You have called an ambulance because you "don't feel well" and will meet them in the lobby of your assisted living - DO NOT tell me you have to go to the bathroom the minute you get into the room.

Specializes in ED.

These are funny I can't wait to start in Mar, but I have to say....If a nursing student, IN UNIFORM comes down from clinical, to the ED with a kidney stone complaint and tells you its his third and toradol doesn't help...Don't assume he is a da*n drug seeker and give him a PO perc. It will insight massive complaints that just upset you, and when the CT comes back with a 4mm stone, it will just make you feel like an a** while he calls out for your ingnorance.

Specializes in Cardiac Telemetry, ED.
DanEMT said:
These are funny I can't wait to start in Mar, but I have to say....If a nursing student, IN UNIFORM comes down from clinical, to the ED with a kidney stone complaint and tells you its his third and toradol doesn't help...Don't assume he is a da*n drug seeker and give him a PO perc. It will insight massive complaints that just upset you, and when the CT comes back with a 4mm stone, it will just make you feel like an a** while he calls out for your ingnorance.

Incite.

I hope you are prepared to be called out for YOUR ignorance. PO analgesia and the opportunity to pass is the standard treatment for a stone less than 5mm in diameter. Just because you say the Toradol doesn't work for you (Toradol works amazingly well for most people with kidney stones because it addresses the root cause of the pain), that doesn't mean you automatically get morphine, Dilaudid, or fentanyl. If you're not puking your guts out, you will get PO pain meds. That does not in any way, shape, or form, indicate that anyone thinks you are a drug seeker. It is standard practice.

I am puzzled over what being a nursing student in uniform has to do with anything.