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.

[Ruby Vee, BSN]

This has been for the most part, a funny and enjoyable thread. If you haven't read through all of the posts, I understand that you don't get that. And I was with you -- both of you -- until you started busting on other nurses. At the risk of being out of line here, I'm going to say that the thread was much more enjoyable without that.

[shoegalRN, RN]

ruby vee said:

This has been for the most part, a funny and enjoyable thread. If you haven't read through all of the posts, I understand that you don't get that. And I was with you -- both of you -- until you started busting on other nurses. At the risk of being out of line here, I'm going to say that the thread was much more enjoyable without that.

Well, I'm sorry, but i was venting.

As an er nurse, I get tired of getting busted on by the floor nurses. I work the floor as well from time to time and i understand both sides of the coin.

In my vent, I don't feel i was being out of line or disrespectful. However, I can't say the same for some of the things I've heard from the floor nurses about er nurses. And i'm speaking for myself, at my place of employment, this does not apply to all floor nurses.

[Cyndi13]

Wow. I've wanted to work in the ER/ED for twenty years. I start ADN (RN) classes this fall. Felt like I was finally realizing my dream.

After reading this, I'm reconsidering. I never want to by this cynical towards a patient. Of course, I live in a small town, not a big city. Maybe things are just that much different there?

But WOW...

[ascRN]

I did not read all 84 pages, so I apologize if any of these are repeats. Like all of you I had a love/hate relationship with the ED.

1. Your mom/dad/grandma/grandpa decided to receive only palliative treatment for a reason. No one forced them into hospice. Those wishes that you or your siblings are directly defying when bringing them to the ED and making them suffer a traumatic arrest or worse will not bring you into the good graces of your ED docs and nurses. Yes, I do know why your loved one appears so gaunt/thin/lethargic. They're DYING, and your inability to cope is not garnering any sympathy.

2. Please don't tell the police you're on PCP, they will be required to bring you here. Furthermore, if you injure one of my coworkers while coming down, five of us will be on you in a second and you'll be in 4-points before you can say "this is bull****". You very well may get injured in the process. Drs: If we ask you to be attentive to a substance abuse pt, it's because we can feel one of these events coming and would like to avoid it. Do us all a favor and get them out of here, or if you have ICU players to attend to, at least honor our request for prn ativan/haldol.

3. Triage is the least fulfilling and most dangerous place to work in the ED. Do us a favor and don't assault/harass your triage nurses. As many people have already stated, you should expect a wait.

4. Don't spread your ****ing quarter pounder w/cheese value meal over my difficult airway cart. If I need it, it need it fast, and all of that will be going into the nearest trash can/on the floor should I come to retrieve it.

[ascRN]

shoegalRN said:

Well, I'm sorry, but I was venting.

As an ER nurse, I get TIRED of getting busted on by the floor nurses. I work the floor as well from time to time and I understand both sides of the coin.

In my vent, I don't feel I was being out of line or disrepectful. However, I can't say the same for some of the things I've heard from the floor nurses about ER nurses. And I'm speaking for MYSELF, at MY place of employment, this does not apply to ALL floor nurses.

I understand this and it's a two-way street. I think the worst experience I had was a floor nurse who called and complained to my charge nurse and then also called ME back to tell me she had complained to my charge nurse. Her complaint: My patient was AMS with a diaper and had been changed but on a stretcher in the hall for 6 hours waiting for a room for admission. He got to the floor and she found that he needed to be changed immediately. Does this suck? Yes, and I get it. It is a common courtesy thing. Did I even bother checking? No, I didn't, because even if I did, I didn't have an open room to move his stretcher into to change him in. Yes, it's night time and that sucks for med-surg nurses because that's when they get all their admissions. But there's a reason for that, it's because the ED is way over capacity from 7 pm to 3 am. There's a disconnect between the ED and other floors because we all have very different priorities and demands placed on us at any given time.

[Christy1019, ASN, RN]

Cyndi13 said:

Wow. I've wanted to work in the ER/ED for twenty years. I start ADN (RN) classes this fall. Felt like I was finally realizing my dream.

After reading this, I'm reconsidering. I never want to by this cynical towards a patient. Of course, I live in a small town, not a big city. Maybe things are just that much different there?

But WOW...

I started in the ed as a new grad and have been there for 3 1/2yrs, at a very large inner detroit level 1 trauma center that sees everything from a multiple gsw walking in the front door, to a child with a bean up their nose.. And quite often patients will yell at me for no reason, or a frequent flier alcoholic will tell you he loves you and want a hug, regardless that he is covered in vomit.. But through it all, i love working in the er, i love how you can never be done learning and that even though you may have 9+ patients with most of them in the hallway, you get the satisfaction of knowing that 90% of the patients who walked through the door feel better now than they did because of you.

I think you are misinterpreting what most of us er nurses are saying, the majority of us are not "cynical towards patients", but you must understand that many of us are frequently witness to unexpected and/or traumatic deaths of all ages, the sickest of sick patients, the dumbest of dumb reasons they came to the er, and those of us in larger facilities are often assigned to ridiculous nurse/patient ratios... And through all of that, we are expected to remain mentally intact and lead normal lives once we punch out.. So yes, we come on here and vent to each other, we make jokes, we tell of sad experiences, we complain about the drug seekers/toe pain x 2yrs/called ems b/c the bus was taking too long, patients so that we can remain sane and not become angry, cynical, miserable nurses and people. If you do decide to go into er nursing, you will one day understand what we say and laugh with us.. But don't assume we are all heartless without having ever worked a day in our shoes...

[Cyndi13]

Christy1019 said:

so YES, we come on here and vent to each other, we make jokes, we tell of sad experiences, we complain about the drug seekers/toe pain x 2yrs/called EMS b/c the bus was taking too long, patients so that we CAN remain sane and NOT become angry, CYNICAL, miserable nurses and people. If you DO decide to go into ER nursing, you will one day understand what we say and laugh with us.. but don't assume we are all heartless without having ever worked a day in our shoes...

Well I don't recall using all of those adjectives, just cynical (which according to the free dictionary online means "Negative or pessimistic, as from world-weariness"). Heartless, angry, and miserable were NOT in my comment, and not my intention, or I would have stated such.

I get statements like the above "Triage is the least fulfilling and most dangerous place to work in the ED. Do us a favor and don't assault/harass your triage nurses. As many people have already stated, you should expect a wait." or "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." and this "If you know what pain meds to ask for, then you know too much and are probably a drug seeker." (and for the record, I laughed and GOT a lot of them!)

My OBSERVATION, however, came from post after post that can only be determined as CYNICAL, such as "I don't care that you're having pain unless it is in your chest, or related to the leg that just fell off." and ESPECIALLY "Just a hint....if you're going to play possum, don't play it in my ED. I can get really personal with a foley catheter really quick. Hey, if you are unresponsive then I want to make sure you won't mess my bed." which implies someone is willing to either perform an unnecessary procedure OR make a necessary procedure unnecessarily uncomfortable because they don't like what a patient is doing. There's no other way to read that, and yes, it disturbs me.

When my son was 18 months he was in the hospital for severe croup and dehydration. All of the nurses were absolutely LOVELY, except one extremely rude night nurse. I had been waiting since 6 pm to hear if the doctor had approved a certain over the counter medication and hadn't asked a soul for an update so as not to bother the nurses with "nonsense" or "stupid questions." But as it was approaching midnight, and the nurse was in the room for vitals, I asked. Not only did she snap at me that I should have asked sooner and now she'll have to wake the doctor to find out, but she proceeded to treat my just-waking-up son like a hunk of meat, manipulating his limbs like a rag doll for an anal temp, and she DIDN'T USE VASOLINE! My son SCREAMED when she inserted that! So YES, BeLLa RN, *I* take it personally when I see a post like that and find it cynical. The amount of posts I ran across that mirrored that opinion were frightening.

When I was a Medic, we had our own set of issues (such as the toe pain x2 that couldn't wait for the bus) and of course we would talk and vent among each other in a sense of comraderie and understanding. AND some of us were cynics and eventually got out of that line of work.

Sad thing is, when I began reading your post, I started to reconsider. Then right on cue you became defensive about something that wasn't even directed to YOU and started making your own assumptions and putting words in my mouth...

So don't be so quick to jump down my throat and take it so personally, BeLLa RN, as it is just my opinion, which admittedly isn't worth much!

(and for the record, when I went to the DON the next day about my son's nurse, I prefaced my complaint with "I know you are used to having people come to you with complaints, so let me start by saying that every nurse before this has been extremely professional, caring, and informative and I am happy they are part of my son's care...)

[mmutk, BSN, RN, EMT-I]

- If you are a staff member here for a needle stick, please understand this is not an emergency. I am sorry employee health is closed but that still does not make your needle stick an emergency, you may have to wait.

[Ruby Vee, BSN]

cyndi13 said:

Wow. I've wanted to work in the er/ed for twenty years. I start adn (rn) classes this fall. Felt like i was finally realizing my dream.

After reading this, i'm reconsidering. I never want to by this cynical towards a patient. Of course, i live in a small town, not a big city. Maybe things are just that much different there?

But wow...

This is a place for nurses to vent. If you don't appreciate the humor or find the venting distasteful, please do yourself a favor and ignore the thread. If you haven't walked a mile in our shoes, you don't get it. Worse, you don't seem to realize that.

[Cyndi13]

RubyVee, I hope you read my second post. I absolutely got the humor and chuckled myself.

While you only found offense with the attack of other nurses and voiced that,

I only found offense with comments like "Just a hint....if you're going to play possum, don't play it in my ED. I can get really personal with a foley catheter really quick. Hey, if you are unresponsive then I want to make sure you won't mess my bed."

As I said in my last post, it "implies someone is willing to either perform an unnecessary procedure OR make a necessary procedure unnecessarily uncomfortable because they don't like what a patient is doing. There's no other way to read that, and yes, it disturbs me." Maybe my own personal experience that I related in my last post touched a nerve that otherwise would have found the comment benign...

Actually, I wasn't going to post anything about anything, until I read your thread and thought this was a safe place to state opinions. I actually left it open that I'm sure small town experiences are completely different from large city, but regardless the poster seemed serious about this, and so that's how I took them... If they were kidding, then I retract my disgust. If they weren't then I make no apologies for my comment, I only apologize for thinking this site was a place everyone could talk openly, no matter what level of "experience" they have or how far they've traveled in anyone's footwear...

And for the record, you are assuming I have NO medical experience. Just because I am not YET an RN does not mean I haven't been in the medical field. I started as a candystriper at 15. By 19 I was an EMT. By 24 I was a CNA. I will be the third generation of nurses in my family. I am not as ignorant to these experiences as it has been assumed. Which is why I laugh at most and take exception to few.

[Christy1019, ASN, RN]

Cyndi

First off, I am sorry that your son had an awful nurse like that, but am glad that the rest of his health care team treated you both well. My response to your post was never meant to be "jumping down your throat", in fact I thought I was trying to show someone who was possibly reconsidering ER Nursing that although it can be stressful, it is rewarding and a great place to work. I also was not intentionally being defensive, but you left your original post quite open to assumption that you meant the majority of us were cynical, you didn't say anything along the lines of "i found the majority of these posts humorous, but i'm starting to reconsider ER b/c of _____..." Forgive me for trying to paint a better picture of ER nursing, but please do not make your own assumptions that anyone who may disagree with you is jumping down your throat or putting words in your mouth, I was simply replying to a post.. as that IS what we do on this site. Lastly, thank you for defining the word cynical for me, but I was quite aware of its meaning already, or else I wouldn't have used it...

[Altra, BSN, RN]

Cyndi13 said:

When I was a Medic, we had our own set of issues (such as the toe pain x2 that couldn't wait for the bus) and of course we would talk and vent among each other in a sense of comraderie and understanding. AND some of us were cynics and eventually got out of that line of work.

You are wise to recall the cynicism that bothered you when you were with EMS, and consider that when choosing a nursing position. Environments vary greatly, but I think that some protective coping mechanisms are universal in the emergency world.

Good luck to you.