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.

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.

Dan, please don't be overly shocked if being a nursing student in uniform does not change the level of care one receives. Even if you are a student in uniform, you will get competent care.

Don't worry. Even if i manage to insight massive complaints from a nursing student in uniform, it will not upset me. Forgetting lunch upsets me. Complaints generally amuse me, unless they are legitimate.

Thank you for your concern, but calling me out on my ignorance will not make me f**l like an a**.

Is this a hypothetical situation, or are you the student in uniform?

Specializes in ED.

It happened to a classmate, I was instructed to go down with him. It was in an area where drug seeking is an issue. I was making a point that sometimes people should be listened to when they relay thier medical hx and be treated for thier pain. I felt the uniform would be a big hint that he didn't come off the street looking for a high. I have brought patients there before, that we knew with pre-existing historys only to hear the staff be flippant about them looking to get high. Saying things like "sure there allergic to such and such, I will get to them later, lets see how it goes for them". Not everyone is like that so I don't want to hear it, but it happens and it's sad.

And Virgo I didn't say it was me, so keep your tone to yourself!

Specializes in Cardiac Telemetry, ED.
DanEMT said:

And Virgo I didn't say it was me, so keep your tone to yourself!

That is irrelevant, and if you don't like my tone, too bad.

Specializes in ED.
Virgo_RN said:
That is irrelevant, and if you don't like my tone, too bad.

Virgo I'm not interested in your arguing with you, go away.

Specializes in Cardiac Telemetry, ED.

LOL! Then don't argue with me.

Specializes in NICU.

Lets not ruin this thread with simple bickering. Back to the venting! (For nurses, not patients...)

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
danemt said:

It happened to a classmate, i was instructed to go down with him. It was in an area where drug seeking is an issue. I was making a point that sometimes people should be listened to when they relay thier medical hx and be treated for thier pain. I felt the uniform would be a big hint that he didn't come off the street looking for a high. I have brought patients there before, that we knew with pre-existing historys only to hear the staff be flippant about them looking to get high. Saying things like "sure there allergic to such and such, i will get to them later, lets see how it goes for them". Not everyone is like that so i don't want to hear it, but it happens and it's sad.

And virgo i didn't say it was me, so keep your tone to yourself!

The fact that someone was wearing a uniform is not a big hint -- or any kind of hint -- to veteran nurses that the patient is not looking for a high. People with all sorts of uniforms -- including nurses and student nurses -- go to the er looking for drugs.

Specializes in Emergency.

Know your meds. At least the names.

Right on about getting off this thread drift, and back to venting.

But first: Dan, it sounds like you are a student wanting to be an ER nurse. I would reccomend you print a copy of your post and save it. After your first year as an ER nurse, pull out the copy and read it. Trust me, you will feel a bit silly about both the content and the tone. While you are at it, re-read Virgo's post after you have a bit of mileage under your belt. You will be impressed by both the accuracy of her reply, and the restraint she used in writing it. Good luck.

And while this isn't entirely back on track , it's close:

Last night a 21 year old, 1st pregnancy with some benign abd pain/unusual sensation. Routine screening.

Me: Do you smoke?

Her: Not as much as I used to. I practically quit. But on my way over, I was so worried that something might be wrong with the baby that I had a cigarette.

Me: That's like being so worried you might get a headache that you hit yourself in the head with a hammer.

Specializes in NICU.
Specializes in ER.

If you walk up to the nursing station to complain about the wait, and everyone is running around like headless chickens, and you have to wait before someone can take a moment to talk to you, maybe you should turn around and go back to the waiting. If you are walking and talking you are so far down on our list right now we can't even remember your name. No, I don't care if you leave, and frankly if someone complained to my boss about the wait they'd be doing me a favor. We've been overwhelmed with work for a long time.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
canoehead said:
If you walk up to the nursing station to complain about the wait, and everyone is running around like headless chickens, and you have to wait before someone can take a moment to talk to you, maybe you should turn around and go back to the waiting. If you are walking and talking you are so far down on our list right now we can't even remember your name. No, i don't care if you leave, and frankly if someone complained to my boss about the wait they'd be doing me a favor. We've been overwhelmed with work for a long time.

I don't understand why patients perceive the threat of going ama as something that will make the er team "sit up and take notice." usually by the time they've used up everything else and gotten to that point in their orificenal you're delighted to see them go!