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.

[badphish]

In the wise words of SGT Hulka " Lighten up Francis"

[badphish]

Sugar9486 said:

I'm going into this field I know that a lot of times it's because they are over worked and under paid, but that is not the patients fault. My view is that maybe if nurses were more polite and kind to their patients maybe there would be more nurses in the field. I think that a lot of the nursing shortage is because people see how nurses act towards them, and they do not want to turn into that. The reason I am becoming a nurse is because I want to help people, I want to care for people, and I want to make a difference, I never would have become a nurse though if I had not met some of the nurses at one of the local hospitals where they strive to be polite and happy. It's a proven fact that when your nice, happy, and polite to people they get better faster, so for the people who sound angry and mean in their posts maybe you should rethink how you act.

So you have no Emergency medical/medical background? Right?

Yes there are Nasty Nurses, THere are Nasty checkout cashiers, servers, Doctors, X-ray techs, Paramedics, FireFighters (gasp!), police officers, flight attendants, pilots, etc etc. Believe it or Not This is a Career, A Job. It's not the Priesthood, or a higher calling. no more than being a mechanic is. we work at repairing the body and sometimes do a lil good for the mind. We are very good at this at least we should be. We need to be recognized for the skills and expertise we have. As long as we say it is a calling and we are here cause we care. we will be paid priesthood wages, be expected to work miracles with less, have too many patients to safely nurse, and treated as second class citizens in this big medical machine.

Of course I could be wrong

[Jenfire, BSN, RN]

How about "I am allergic to everything except Dilaudid." Yeah not gonna happen. lol

[wannabeagreatRN, BSN, RN]

I love these, they are so true! While in nursing school I was a tech in the ED. Maybe a little off topic but I want to share one of my pet peeves.

One of my many duties was to transfer non-telemetry patients to their rooms up on the floor, and it drove me crazy when the nurses on the floor would ask me how many admissions we had for them, or how busy was it down there and then act all s***y towards me about it. Yeah duh, I really caused it! Especially on the days that I was still sweaty from the 2 or 3 codes we had had so far, and the 3 psych codes I had just been assualted by. Good Grief!

[Viviana, ASN, RN]

Here's another: Don't ask me for "something for nausea" around a huge mouthful of pizza.

[JSlice., ASN, RN]

What a great blog!

MORE....

1-Shutup while I'm trying to hear your lungs and heart with the stethoscope. Tell your family to shutup so I can hear your lungs and heart.

2-This is not a bar! Do not come into the ER to pick up on the nurses...If you're well enough to scope out the girls, you don't belong here!

3-I am triaging you! NO, you can't lay down in the triage room! Get to the point of your problem. I don't care about the insignificant details about you hurting your finger.

4-I need a urine sample! If you were fine enough to walk into the room, then you should be able to take off your pants to pee. No can do? OK, here comes the straight cath. Hold Still.

5-No, I don't have pillows for you. This is not a suite. The beds are hard and small and you are a giant pain in the butt.

6-You were well aware you would come to the ER and end up waiting. I have a patient having an MI next door and you have pink eye. Wait or sign AMA.

7-It's too bad your IV was placed in an area that you didn't like. And no, I will not change your IV site.

[JSlice., ASN, RN]

No doubt! Exactly what I was thinking. If you know each narcotic-which one works and which one doesn't, then you know too much.

[traumaRN1908, RN]

I preface this with:cool:to all the ED nurses out there LOL

Please do not be the MD that picked up the pysch patient(that is also allergic to haldol, geodon, risperdal) the just tried to hit me and 3 other nurses and had to be restrained by security for attempting to attack someone else and is now in 4 point restraints and wonder why we give you the eye when

A it takes multiple SOS/distress calls to get your attention(and said MD is not with a critical patient) and

B we get a one time dose and you walk away to let us handle it.

Please do not think that somehow because you are RN, MD, RT, PharmD at the hospital (and feel the need to point this out to me, or bigwig in the community that this will expedite you or your family members ED visit*, or get you the room of your choice if admitted. If you have strings to pull please do so, as it is guaranteed as soon as I call admitting and mention your request you will get the exact opposite.

* This really amazes me that you think you should be entitled to better care because you know someone.We do the best we can regardless of if you are the frequent flyer(also homeless) that comes in really sick one day or if you have a posh address and are wearing designer clothes. It is one thing to get an extra visitor pass, entirely different to think you should go to the front of the line because of social status/connections. Nevermind, that you do have advance medical knowledge or general education and should know what it means if you see the auto chest compressor being run up the hall(or your code pager beeps at the same time you see the blue light blinking at the main nurses station) at the same time I say please excuse me I will send someone else with your blankets/water/magazines......

[miss81, BSN, RN]

This one is for the Canadian ER nurses...

If you come to the triage room with a Tim Horton's in your hand then you're getting a level 5... if you had time to go to the drive through BEFORE the ER then your not that sick!

[DeadHeadRN, BSN, RN]

erdiane said:

13. Don't call your relatives on your cell phone to tell them we are mistreating you for not completely relieving your pain and them have the call us and threaten us with the old "I know someone!" line. We are not impressed.

Oh my this reminds me of one night a few weeks ago. I was triage that night, and the way our ED is set up, triage is completely separated from the main ED. So I had triaged a gruesome twosome, both there for back pain (one of my favorites). So the two of them walk up to my window and before the lady even opened her mouth the little light bulb in my head popped up - "DRUG SEEKER!!!" Anyway, I triage them, and they eventually go back to be seen. The lady's father is now in the waiting room pacing and carrying on that we won't let him go back to visit her. Just a side note- If we ask visitors to leave the ED there is a very good reason, in this case we had just had a 2 month old code who did not survive (SIDS), so no visitors were being permitted in. So he's carrying on, and now I won't let him back just on principle cause he's ******* me off. So he walks up to my window for about the 50th time and proceeds to tell me that his daughter just texted him and she would like her Dilaudid now. Really? I told him I'd be sure to pass that message along. Needless to say his darling daughter got no Dilaudid that night.

What is wrong with people?

[DeadHeadRN, BSN, RN]

Sorry if I'm repeating here, but I don't have the energy to read 83 pages of posts. Here are my pet peeves:

1) Calling 911 for an ambulance because you think it means you won't have to wait, think again. If your here for nonsense, ambulance or not, you will be triaged and sent to the waiting room. And no, you cannot have a taxi voucher for a ride home when you're d/c'd. It's really not my problem or concern how you get home.

2) If your here because you have nausea and vomiting with abdominal pain, you will not be getting something to eat. Use your head.

3) If you walk up to the nurse's station to ask for a something for your family member/friend, please specify who you are talking about. Don't point in the general direction of the pt and say "she wants a blanket." First of all you can walk up the linen cart right next to you and take as many blankets as you want for "her," and secondly, I don't know who the hell "she" is. This is a 50 bed ED. Please be a little more specific. I forgot my mind-reading powers at home today.

4) If I am in the middle of something important such as chest compressions, please don't yell at me through the curtain that you want a glass of water. You're just going to have to wait. Or maybe I should stop what I'm doing to be your waitress. "Oh I'm sorry, you're chest compressions are just going to have to wait, the pt next to you wants some water."

5) Please don't stalk me to find out if your sister is ready to be d/c'd yet. I promise you, I want her gone just as much, if not more than you do. If I haven't been over with her papers to d/c her it's because A - I'm doing something more important, like saving someone's life, B - She's not up fo Discharge yet, or C - the doc hasn't given me the papers yet. Whatever the case, I swear I will be over to get her out of here as soon as humanly possible, if for no other reason than to get you off my case.

6) Giving me the stink eye from across the ED is not going to make your family member's test results come back any faster.

7) When I come over to start an IV, don't ask me if I'm good at IV's. I'm an emergency nurse, yes I am good at them. I can blood out of a stone. Asking me that question does nothing but aggravate me.

8) Please don't complain that you've been waiting in ED with grandma for 2 hours now. 2 hours? That's nothing!

9) If you come the ED because you've got abdominal pain and you've been vomiting for 4 days, you are going to get an IV, you are going to have a CT of the abd/pelvis, and you are going to have to wait a few hrs for all of this to be done. Don't try to refuse these things. If you don't want us to help you, why the hell did you bother coming in?

10) Don't tell me you have 10/10 pain and then proceed to walk around the ED to find a snack, talk on your phone, play a game on your phone or text your friends. I had a compound fracture of the humerus. I know 10/10 pain and trust me, I wasn't chilling out talking on the phone.

11) Don't bad mouth my coworkers. The physician that you're ******** about to me because she won't give you Dilaudid, is someone that I work with everyday. She knows what's she's doing. I know her husband and her children. She is a close personal friend of mine and talking bad about her is going to get you nowhere fast. And I promise, making disparaging comments about her isn't going to get that Dilaudid anytime soon.

12) If you just left you PMD's office 2 hours ago, and he or she gave you a script for Cipro for your UTI, please don't come to the ED after taking one dose and tell me it's not working. Use your head!!!

13) I will be happy to get you a glass of water if I have time. Please don't call the nurse's aide over and tell her you need to see your nurse right away and then ask me for a glass of water when I come over thinking something is terribly wrong because you needed me "right away." Unless your having chest pain, respiratory distress, paralysis of one side of your body, Vfib or asystole, you don't need me "right away." And here's a tidbit of information to remember - the aide CAN get that glass of water for you. Better yet, if you're a walkie-talkie you can get your own glass of water.

14) When you hear an announcement asking ALL visitor to please return to the waiting room, please do not ignore it. This applies to you. If we're asking you to leave, we have a very good reason for doing so, and you are not special, and you are not excluded.

15) Keep in mind that you will get a lot further by being nice to me than by being a jackass. Being nasty to your nurse isn't going to do anything other make things take a lot longer than they need to.

16) I am not a waitress, a therapist, a doormat, or a punching bag. I am not your buddy. I am an RN, not a servant.

17) If I am sitting at the nurse's staton, it doesn't mean I am not in the middle of something important. I am not being lazy, I am probably documenting something, speaking to the physician about something, looking up a drug, looking at test results, looking at a pts heart monitor, Giving report to the floor nurse, etc. If I am using a computer, I am not surfing the internet (honestly, I don't have access to the internet - I don't a have a password for it).

18) If your child has a fever, please give him or her Tylenol.

19) Finally, and this is just an FYI, the curtains separating the beds? NOT SOUND PROOF BARRIERS!!! Believe it or not I can hear what you're saying!!!

And here is just a note to the nurses on the floors or the Units - I swear I didn't go out into the street and flag these people down begging them to come in. I promise, I didn't write the admitting orders, and I'm sorry if you don't like them. If this is the case, please take it up with the physician who wrote them, don't yell at me about them. I'm sorry that you're upset that you're getting a patient, but that's the way hospitals work. If you have such an issue with getting admissions, maybe you shouldn't work in a hospital. I'm also sorry that you have however many other patients it is that you have, and don't feel like doing the admission paperwork on this one. Keep in mind that I've also given 7 other patients to the other floors, discharged 5 people, and I have 4 telemetry holds and 2 ICU holds. Your night could be as bad as mine is. Please just take the report, and save the attitude for someone else. I'm just trying to do my job.

[shoegalRN, RN]

Here's mine:

-If I am triaging your family member, please let them speak for themselves. If I ask where is your pain and if you answer "it's in her chest", I will ask you in the nicest voice that I have "can she not speak for herself?" Then I will ask you to kindly go back out into the waiting room until I am done. And if you get an attitude about it, I will call security with the quickness.

-If you are allergic to everything under the sun EXCEPT that pain medicine that starts with a "D", then I am convince you are a drug seeker.

-If you are shouting about how long the wait is, that shows me you have a very patent airway and will be waiting longer.

-If you come in by EMS along with 2 police officers, handcuffed to the stretcher, don't tell me "I only had one beer". You will be getting an 18 gauge IV, fluids going, and hooked up to the monitor to make sure you don't go into DT's.

-If you have abdominal pain, dont ask me if I can get you a box lunch. The answer will be NO.

-Pregnancy tests only cost $1.00 at Family Dollar. Try going there.

-When I ask you the reason for your visit to the ER, please state the facts and the facts only. I don't want to hear the story about your "baby moma". Get to the point already.

-When a trauma comes in and the police has the front entrance of the ER blocked off as a crime scene, don't try to go outside and smoke to be nosey. You will be asked not to leave your room. If you insist on leaving, the cop will stop you at the front door and direct you back to your room. And no, it's not your business what happened.

To the floor nurses:

Listen, I'm not going to give you a complete head to toe report. I'm only going to state the diganosis, the history, the IV placement, the last set of vitals, and the last meds I gave. If a pt comes in complaining about chest pain and has a positive troponin, no I didnt listen to his bowel sounds, no I don't know how much urine output, nor if he has any skin issues. That is for you to determine when the pt gets to the floor so you can do your own head to toe assessment. This is the ER, we are only going to focus on the chief complaint.

And please don't get snarky with me when I bring the pt right up after I gave you report and your room is not ready. You have been notified you were getting a new admit an hour ago. I understand the floor gets busy, and if I have time I will help get your room ready if I'm there with the pt. But don't get upset if I didnt draw a lab that your inpatient doctor ordered as routine and part of AM labs. ER only works on STAT orders. We have one hour to get the patient up to you and you need to assume pt care and do what labs needs to be done that are not STAT.

I understand how the floor can get busy, I work Stepdown from time to time. But some of you floor nurses don't get how the ER can be VERY hectic. If we are holding an inpatient waiting on a bed, that patient is NOT the priority unless they are crumping or coding. Our ER pts are the priority and if we get a trauma, we drop everything and go to that. I'm sorry if your inpatient didnt get their schedule stool softner. I'm sorry if your inpatient has meds that were not given by the time I get them to you. However, I was working with a pt in SVT where I had to slam Adenisone, had to drop everything and go to a trauma, and had to help intubate a pt. So, no, your inpatient was not the priority, so don't talk mess saying "my pt been down there for hours, why havent you passed any of these meds".