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.

[lpnstudentin2010, LPN]

medsurgnurse said:

What has happened to you in your 18 years of life that you have been exposed to these medications? Are you a burn patient?

I have benign tumors and have had loads of surgeries.

[adnstudent2007]

"Syncope is not an emergency unless you are old or have a major medical problem. Drink some damn water and take a nap, I almost passed out on my way down the hall to check you in, suck it up."

My one time as a patient in an ER I had been fine and then I turned a lovely shade of paste grey and fainted while having an X-ray taken. I was quickly taken out of there, wheeled back to my room, and I had several doctors and nurses standing around me and trying to figure out what happened. I thought I learned the trick to getting faster treatment when waiting for a while in the ER!:chuckle

[MomNRN, BSN, RN]

Amen sisters and brothers!

All the above are true. Makes you appreciate normal, clean patients who have a true medical emergency.

[NurseLatteDNP, MSN, DNP, RN]

kstockdaleRN said:

Love this thread!

I don't work ER, I work cardiac, but I totally feel for you folks.

My additions:

If you berate the nurses, scream about needlesticks from phlebotomy, etc. you can bet that your IV will need changing and it will be a 16 or 18.

If you go to administration because it took the nurse 10 minutes to get you your darvocet, and you think it is because you are a minority, you can bet that we won't kiss your @$$ the rest of your stay and wait on you hand and foot.

If you tell us that you have sued this hospital once before, and you think it's a bad hospital, you can bet that will we chart every word you say verbatim.

If you have horrible chest pain, but "nitro doesn't ever work", you can bet you get three nitros every single time, and EKG, and call the Dr. before you get any morphine. Also, in this case we have very little sympathy for nitro headaches and tylenol is the remedy, not demerol.

If you point out the vein that you "normally use" and swear its a good one, I refuse to use it, just on principal.

If you threaten repeatedly to go AMA, and you are waiting for open heart surgery, I will soon get tired of trying to convince you to stay. Again, AMA paperwork is much simpler.

Just because the ER asked you a bunch of questions, this does not mean that I can "call the ER nurse" and get all the answers. I WILL ask them to you again, and I don't have time to listen to your griping.

Just because you demand a private room does not mean that we have one. Just because you SEE a private room open, does not mean that its not assigned or that I don't need it for someone really sick (see post one)

Just because your roommate is annoying doesn't mean I don't think you are too.

If you can't remember your own meds or take them correctly and you are an adult person who is not senile - why do you think that I am psychic and know what your "water pill" and your "blood thinner" are and the exact dose?

If I ask the question "so, who wipes you at home?" you know I am getting ticked off and you better do something for yourself if you intend on going home tomorrow.

If you want to complain because it took 5 sticks for us to get an IV in you - then why did you pull it out?

If your family calls the floor every 5 minutes checking on you, I won't have time to take care of you properly.

If you want me to mediate between you and your half-sister's husband, etc. and not allow them in the room - I am not Judge Judy. Work out your own problems.

If your refuse meds and procedures but still want to get well, then get out.

No, you cannot plug in your cell-phone charger right in front of the "turn your cell phones off, please" sign.

If your chest pain is a 10 and you are flipping channels and eating a big mac your family brought in - I am much less sympathetic.

If your senile mother in law is in the hospital and you are trying to get her to sign and make you power of attorney, I will not witness it.

I do not know how much each pill costs, and I have 500 more to give today. I know what they do, what their side effects are, and why you need them. End of story.

No, I will not give you a portable oxygen tank so you can go out and smoke.

I know all of this is not stuff anyone is taught in nursing school, and I truly do care about most patients. It is those few patients that you always remember though.

Good luck, everyone!

Some of these I just can't laugh about. I think few of your statements are plain mean.

[RunnerRN, BSN, RN]

ICURN_NC said:

1) Don't complain to me about how long your wait was before you got your room. Trust me, I can tell that the ED didn't want to keep you any longer than they had to!

2) Don't complain about your ER nurse. By definition, I like her/him better than you. It's like the Fraternal Order of Nurses. This just makes me believe you will complain about me when you get out of the ICU to the floor. Why do I want to go out of my way for you?

6) Every time you threaten that you will never come back to our ED or hospital, we all pray that you mean it. This is not a threat, it's a blessing.

7) If you threatened/abused/mistreated anybody in the ED, we will find out and then restrain you. We are good at it. We have lots of practice.

Thanks to you guys for being on the front line.

I ❤️ You!!!!!

And thanks to you ICU nurses for having the patience to go the long haul with patients; I get bored with them after about 5 hours ?

Amen to #6! You are more than welcome to leave and go to the other ERs in the area, but I guarantee you will wait just as long there. AND you'd better believe that once you complain about the wait and the nurses at our hospital to the nurses at that hospital, you will lose all credibility!!

[rosieseattle, RN]

I think perhaps we should also remember that if it were not for our patients, we wouldn't have a job. I also think that some of you might feel somewhat different if you ended up being the patient in the ER. Sometimes, it is only a "gut feeling" of a parent that convinces them to rush to the ER with their child. Everybody...yes everybody that checks into the emergency room has an unmet need or they wouldn't be there. It's YOUR job to suck it up and do your job without whining and judging the human being that is there for care. If you don't like it,...then YOU go somewhere else. The hospital doesn't belong to just you, it belongs to the people...the homeless, the poor...the ignorant and the drug abuser and the alcoholic...the repeat offender...whatever.

[LeahJet, ASN, RN]

rosieseattle said:

I think perhaps we should also remember that if it were not for our patients, we wouldn't have a job. I also think that some of you might feel somewhat different if you ended up being the patient in the ER. Sometimes, it is only a "gut feeling" of a parent that convinces them to rush to the ER with their child. Everybody...yes everybody that checks into the emergency room has an unmet need or they wouldn't be there. It's YOUR job to suck it up and do your job without whining and judging the human being that is there for care. If you don't like it,...then YOU go somewhere else. The hospital doesn't belong to just you, it belongs to the people...the homeless, the poor...the ignorant and the drug abuser and the alcoholic...the repeat offender...whatever.

~sigh~

OK guys, I think the fun is over. The righteous indignation has finally made its way onto this thread.

It was fun while it lasted....sharing and relating......but I fear now it's just going to decline into "you badbad ER nurses" and I don't know about ya'll, but I don't feel I need to defend myself.....:)

[rosieseattle, RN]

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.

[momdebo, BSN, RN]

too bad, I needed the chuckles. Thanks to all the ER nurses, they are truly special people.

[EDValerieRN, ASN, RN]

rosieseattle said:

I think perhaps we should also remember that if it were not for our patients, we wouldn't have a job. I also think that some of you might feel somewhat different if you ended up being the patient in the ER. Sometimes, it is only a "gut feeling" of a parent that convinces them to rush to the ER with their child. Everybody...yes everybody that checks into the emergency room has an unmet need or they wouldn't be there. It's YOUR job to suck it up and do your job without whining and judging the human being that is there for care. If you don't like it,...then YOU go somewhere else. The hospital doesn't belong to just you, it belongs to the people...the homeless, the poor...the ignorant and the drug abuser and the alcoholic...the repeat offender...whatever.

Too bad that unmet need is often a shower

I'm kidding... kind of. Like I said in the original post, I love my job and don't want to go anywhere else. I even like my job enough to come here and vent about it rather than to tell the patients my "rules."

I'm not doubting that everyone presenting has a need... I'm just thinking some people need things I can't give them.... like a good kick in the rear.

[Sugar9486]

I do not know how much each pill costs and I have 500 more to give today. I know what they do, what their side effects are, and why you need them. End of story.

Why are you a nurse then? I know that in my nursing program we have to know what side effects are and why the person needs them, if we do not then a paper with this information on it is given to the patient.

I totally understand how all of you feel, I was a very clumsy child and bleed profusely many times as a child, and then suffered from some migraine headaches that weren't by the book, and were not easily diagnosed, so I've seen many of these people in the ER. I know where you are coming from. Look at the situation from the other side though, yes, there are people that go to the er for the drug habits, but many of the people who may not have an emergency by your terms are scared, or they would not be there. Most people do not like to spend their time in the er and if they were not scared or in pain then they would probably not be there. I have been to a few ER's in my area and I noticed that many of the nurses do not seem very satisfied with their jobs and therefore are right out mean to their patients, this is not fair. This may be your place of work, but it's the patients right to come there... If you are an er nurse that doesn't think a patient has the right to be there, then I think you are working in the wrong part of the hospital. I went to one hospital that advertises that they are working on happiness and cheerfulness. These were some of the best er nurses that I have met. They were caring and happy and even if your problem really did not mean much to them they acted as if it did anyways. That night I did not see very many people at all that were angry or yelling. The patients were then taken care of faster. Maybe instead of complaining all the time you should just smile and say okay I understand you hangnail hurts. It may not be an emergency at all, but you do not have to waste your precious time that can be used caring for someone who really needs your help arguing with the person that has a hangnail.

I know that everyone needs to vent sometimes and that it actually makes you feel a lot better about your job, but just think about the other side of the situation.

I had nurses tell me that they thought I was "faking it" because I did not look like I was in pain. What does pain look like? How are you to know that I am not in the worst pain if my life? When the ultrasound came back and showed that I had some of the biggest cysts on my ovaries that they had ever seen, they looked a little shocked... If your going to spend your life caring for people, then you really need to care for people.

[LeahJet, ASN, RN]

EDValerieRN said:

Too bad that unmet need is often a shower

I'm kidding... kind of. Like I said in the original post, I love my job and don't want to go anywhere else. I even like my job enough to come here and vent about it rather than to tell the patients my "rules."

I'm not doubting that everyone presenting has a need... I'm just thinking some people need things I can't give them.... like a good kick in the rear.

Valerie, there is no need to defend yourself. We know that we are all good ER nurses.

The one who is doing the chastising made a post in "most ridiculous ER visits".... I believe it was "my nipples get hard when it is cold". I wonder what need needed to be met there:uhoh3: