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 ED/trauma.
ruby vee said:

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!

Amen!! Then which ever staff member states to the md that the pt is "threatening to kill themself" will be met in the parking lot by a bunch of angry er nurses!!

Specializes in Med/Surg.
ruby vee said:
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.

Was thinking the same thing, virgo. the uniform doesn't mean a thing.

Anyway, also agree with the ama threats. I don't work er (so maybe I shouldn't be here, or at least not be posting!) but we get that threat on the floor, too. "I'll just leave!!" "great, I'll help you pack up your stuff!" :D

Specializes in Cardiac Telemetry, ED.

Just because you say "please" and "thank you" does not make your incessant, needy requests any less annoying.

lpnstudentin2010 said:
Not necessarily...I am allergic to pretty much anything besides fyntilal (sorry dont know how to spell it) I am allergic to morphine, dilaudid, and oxycodine so if i need a STRONG pain reliever I think that is the only one I can take. and i am NOT a nurse yet or a nursing student

If you are not in the nursing profession, you will not get our humor. Please hold your judgement untill you have the experience.

emtb2rn said:
Know your meds. At least the names.

Ditto. "I take a blood pressure medication" is not enough, for pete's sake! It really makes everyone's job a little easier, and saves a phone call to your pharmacy. It really sucks if you don't know your drugs and the nurse or scribe or unit secretary has to call your pharmacy on a weekend. And it sucks even more if where you get your drugs happens to be closed on a weekend. This happened just yesterday.

1 Votes
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I had this one recently: "allergic to unknown antibiotic." Okay, great. I guess we'll start giving you abx and see which one you don't like. LOL.

Specializes in Emergency.

"Remember that patients can and will vote with their feet based on word of mouth about ER experiences."....Sound like and administrator to me...GET HIM!!!

peds4now said:
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.

Oh, then I must apologize profusely that the ER no longer has to deal with all the drug-seekers, uneducated parents and drama queens who will high foot it to another facility after they saw this completely unsensitive post; most of whom have no intention of paying the bill that they incurred due to their lack of judgement.

As you so succintly put it, the mother of a child with a moderate fever SHOULD NOT HAVE BEEN IN THE ER TO BEGIN WITH!

Specializes in ED staff.

If I call your name for triage and you're outside talking on your phone or smoking.... I'm skippin' ya!

IF you can scream "I'm in shock" at the top of your lungs: you're not.

Specializes in ER.

Or "I'm going to pass out!" Go for it- you're in the right place, and it won't slow me down at all.

Specializes in ED.
rosieseattle said:
You bet it's over. Take it from someone who has almost died twice in the ER, primarily by being blown off by the RN in the ER.

it's funny how they are quick to blame the RN for their near death, pain, etc. While the Docs get the praise when things go well. So you weren't saved by those same nurses from near death twice?

1 Votes