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.

[itsnotaspiderbite]

EDValerieRN said:

That's why the original poster said "probably" a drug seeker, not "always" a drug seeker.

You would be amazed at the number of patients who are "allergic" to everything except (insert drug of choice).

If your allergy list reads: ASA, ibuprofen, acetaminophen, morphine, and hydrocodone...but you tell us you can take that duh-dil? something, or that fentasomething...A) hahahaha, I call shenannigans. or B) you don't know the definition of "allergy".

[Altra, BSN, RN]

itsnotaspiderbite said:

If your allergy list reads: ASA, ibuprofen, acetaminophen, morphine, and hydrocodone...but you tell us you can take that duh-dil? something, or that fentasomething...A) hahahaha, I call shenannigans. or B) you don't know the definition of "allergy".

Agree.

And I love your screen name, too!

[frenchfroggyAPRN, MSN, LPN, RN, APRN]

Had a man in triage last week, came in CC "just dont feel good, need to see a doctor" After more questions, found out he had been seen the day before by his PCP received Rx for MDI and ABO, surprise , he didnt get them filled because Medicaid wouldnt pay for the MDI that " I really need". I explained that we dont give them out at the ED, he became irate and said well, I dont need to stay then. As he was leaving, I was explaining for him to come back if he had worsening symptoms, while I was talking, he told me to SHUT UP, I am tired of you people telling me what to do. Then he wanted a card with our number on it if he became sick. He seriously asked what number to call. With a straight face, I looked at him an said 911.

[AngelfireRN, MSN, RN, APRN]

Snort, sounds like what I deal with every day.

"What do you mean, you don't have samples of the 20-year old med that's on the $4 list?"

This thread is so cathartic, lol.

[carolmaccas66, BSN, RN]

* To all the people lined up in beds, in triage in the corridors and in chairs -there should be a sign saying that when we are NOT on divert, it means that all the beds in the state are FULL. That's why you are waiting and that is why we are not diverting the ambos - they have nowhere else to go. Our SC (shift coordinator) has the phone glued to her ear trying to find out where available beds are - she's doing her best under difficult circumstances, & is trying to get more staff to come in (if the budget allows, which it usually doesn't).

* Don't curse at me cos there are no beds. I have told you you have to lobby your MP and complain to the government - they need to build bigger hospitals. The suburbs around us have exploded with more people, but the hospitals haven't kept pace. There is no point yelling at me - I can't make a bed magically appear.

* Do not expect me to feel sympathetic or even empathetic when u chose to go out and get blitzed on 20 different types of alcohol, get in ur car KNOWING ur drunk then u crash into a nice family we are treating, u get admitted laughing your head off, then u try to tell me YOUR side of the story whilst calling me 'darling' as well. I am not your darling, nor anyone elses, nor do I want to be at this point in my life. I don't care if you use that term with everyone - and I don't want your alcoholic breath steaming over me as I try to do your neuro obs.

* OK so you're a pscyh patient. You seem to think this will entitle you to special treatment for some strange reason. You say you've been off your meds, but you are able to call ALL your family members in to see you (who turn up in droves), you are able to demand a meal then complain it's not what u usually eat, you are able to get antsy & nasty when you've waited too long and you can do all the usual ADLs. So what was your problem exactly?? (The particular patient called all his family in to see him and no joke, about 40 people turned up. Told them all no way are you all going in there to see him. I think they thought they were going to have a massive party or something, cos that's what it nearly turned into).

Where has the accountablilty for patients actions, and respect for health care workers gone? Does it not exist anymore?

[carolmaccas66, BSN, RN]

Me in ED: Sir what medications are you on, if any?

Patient: I have high blood pressure. I take that little white tablet that you get, you know the one.

Me: Did you or your partner/family member bring in a list of your medications, or bring your medications with you?

Patient: No, why would I? Don't you know the medication I'm talking about? You're not a very good nurse if you don't know. Where's the doctor? I bet HE will know what I'm talking about!

Walked away after that and wrote on his chart: 'Takes little white pill for high blood pressure'. I think we got a list faxed from his GP but you can't do that at 2am - why don't patients realise this?

[carolmaccas66, BSN, RN]

Please, please, PLEASE peoples, try to have a bath and clean your teeth EVERY DAY! This may come as a shock to you to have to do this but yes it IS necessary, and makes life so much more pleasant for all of us! (And I'm not talking about really old & inform/ill people). I'm talking about the A&O lady who came in the other day, and who's breath could have felled trees! Every time I had to bend over her I had to breathe through my mouth - her teeth were disgusting & I have noooo idea how her hubby could even go near her let alone kiss her *shudders* ++++

Can't stand really bad smells now & esp halitosis gone feral!

[carolmaccas66, BSN, RN]

To the critical persons on here:

It is called EMERGENCY for a reason.

- Back pain you have had for 20 years, & countless ED visits, is not an emergency.

- Being bitten by a tiny dog where the skin is only grazed, and your shots are all up to date & where there is no blood etc, is not an emergency (the woman that came in with this kept going on about how the dog had ruined her recent, very expensive manicure).

- If ur child has a bit of a runny nose, no other symptoms and they are crying a bit - that is not an emergency.

- If ur relative is obviously palliative care & they are dying, bringing them into the ED won't prolong their life. It just makes ur relative suffer more pain being moved around. This is not an emergency.

- And I cannot stand the ones who are high on drugs and drink. Time wasters, the whole lot of them. Or the ones on the above who have caused, and will continue to cause, MVAs & deaths on the road. They are not an emergency & I wonder why we 'treat' them. Most of them just sleep it off till the next time & may get re-hydration - that's it. No emergency here.

People here get free health care = abusing the system for anything & everything. I work with some doctors who will only give panadol now - they will not give anything stronger on principle. This is to force people to be d/c & go to their primary care provider & stop using the ED as a primary provider instead.

Thank God I don't work in the ED all the time. People have forgotten what real emergencies are.

I find it sad that our society has degenerated to the point where we abuse the health system. I understand some people have uncontrollable & intractable pain, but the ED can't help them long-term. They need to take accountability for themselves & go see their specialist or pain team, which many don't bother doing. They don't follow ANY instructions given to them, even basic ones like taking panadol every 4 hours to help with pain. And what annoys me is that they say they take oxycodone regularly but it still doesn't help them with their pain & some have never tried regular panadol, for example. Then the ED staff get the blame when we refuse stronger meds, & we're somehow nasty & unfeeling.

To all the haters on here: I get your pain and your point. I think most of us have been to the ED at one time or another, I know I have. But most of us don't abuse the system, whilst many others do. I did a thread not long ago in that maybe experienced nurses become too cynical. Perhaps we do in many ways - I know I have. But why is it always the nurses fault when a patient feels they aren't getting good care? We don't control the whole ED.

I would suggest to any on here that feel aggrieved, direct ur anger towards everybody, not just the nurses, and do make a full on complaint - that is ur right after all.

And I for one, am tired of getting the blame for everything - not everything that happens to every patient is my fault. Usually, the patient creates their own nightmare because they won't follow instructions, are rude, nasty & abusive and want the world to acknowledge them. We try to acknowledge them, but boy, many people just makes their own lives MUCH harder than they have to be!

[DixieRedHead, ASN, RN]

Me Triage: "What is your emergency today?"

Patient: "I hurt my back."

Me: "Did you do this at work?"

Patient: "No I flipped my four wheeler. I am on disability."

Me. "What is your disability?"

Patient:"$700 a month."

Me: "No I meant what is your medical diagnosis for disability?

Patient: "Back Problems"

Me: "And you were riding a four wheeler?"

Can you stand it?

[AngelfireRN, MSN, RN, APRN]

Not only do I have to stand it, I have to deal with these jokers every day I work, too.

"I'm trying to get my disability."

"For what condition?"

"My nerves. I just can't handle life. I never have been able to."

But yet , we have to handle life and take care of your sorry, lazy, leech of a self.

[Ruby Vee, BSN]

angelfirern said:

not only do i have to stand it, i have to deal with these jokers every day i work, too.

"i'm trying to get my disability."

"for what condition?"

"my nerves. i just can't handle life. i never have been able to."

but yet , we have to handle life and take care of your sorry, lazy, leech of a self.

It probably ought not to, but i confess it absolutely shocks me that people are seeking disability because they cannot cope with life.

[frenchfroggyAPRN, MSN, LPN, RN, APRN]

Triaged a man cc back pain when asked was he employed, "No I am disabled" when asked what is your disability "my back".

When asked what was he doing when his back pain started today lifting a refrigerator. I asked him, aren't you not supposed to do that since he was on disability for his back, he said and I quote "I don't like to work, you gotta do what you gotta do" that really chaps my hide. I worked a 12 hour shift on a severely sprained ankle and didn't complain a bit, just had a shot of Toradol (wonderful drug) and here is this healthy 30 something on disability getting paid to sit on his rear end.