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 ICU, Tele, Dialysis.

I think these nurses do care for people, understand that the caring ones are on here, venting, so they can continue to care for people, the ones who are out there actually saying these things to the patients are the ones who need to be worried about. I think we all need to understand that we work in an environment that few people on the outside can understand and that this is all in fun. ER nurses see some of the most awful, heartbreaking, mindbending things and overall are people with great fortitude and I think it takes special people to do thier job!!!!

Specializes in Emergency Room.

For the few people that have come into this discussion and insinuated that we are AWFUL people who shouldn't be allowed to live anymore.....WE ARE VENTING!! No, we do not say these things to our patients, and 99 times out of 100, I treat everyone the same. No, I won't be in the stable abd pain pt's room as much as the unstable GI bleed with no blood pressure, but all of my patient's immediate medical needs are met.

Until you train your ass off, learn how to care for 1000 different kinds of illnesses, and work in the ER for a time, you cannot begin to comprehend the crap we deal with. It is a chaotic atmosphere, and we must prioritize our time and energy. Wouldn't you rather I spend my energy on the sick sick (see post 1) patient rather than the non-sick abd pn patient? And yes, a lot of us CAN tell pretty quickly who is sick and who isn't.

I am not saying that the ER is "better" than anywhere else. Although to me, it is.....I could never work anywhere else in the hospital. It is impossible to describe what it is like to do compressions until you're sweaty and your arms are ready to fall off, call that code, then walk into another patient's room (not sick pt) and hear a bunch of complaints about how mother is cold/hungry/hasn't been to CT yet. The thing is, most people don't stop to think about the other things that may be going on....maybe mother hasn't been to CT yet because we were holding it for the 5 level 1 traumas that came in at the same time (happened to me last weekend).

Emergency rooms are for emergencies. Urgent cares are for urgent needs. The doctor's office is the place for that annoying arm pain that has been going on for 2 months. I wish people could walk 100 feet (it wouldn't even take a mile) in my shoes before calling me a "bad nurse". And yes, I have been on the opposite end (the pt) and I make it a point to be as calm and easy going as possible. Because, as long as I'm still breathing, there are people that are sicker than me.

Specializes in ER, ICU, Infusion, peds, informatics.
edvaleriern said:
Too bad that unmet need is often a shower :lol2:

Or a ride to the grocery store that is accross the street from the er entrence......

Specializes in Peds ER.
LeahJet said:
~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.....:)

Shucks, it was so fun while it lasted. Thanks to everyone who contributed their "rules", they were hilarious.

I understand what you are saying, and if you told my post as telling you that you are a horrible person, then maybe I did not write how I meant to write. I know that there are people who are not sick in your eyes, and there are people who are not sick at all that come to the ER, but the fact is that regardless you have to treat them. I am not speaking about the nurses who treat every patient the same way... As I said before I have been to many hospitals in my area and many of the nurses are rude and nasty. 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.

ER nurses take a lot of crap, everyone knows this, and it takes a special person to be an ER nurse, you guys come on here and say some of the most hurtful and rude things and make me want to rethink my career choice... Think about the effect of your words to others... they do make a difference.

NurseErica- I'm glad that your one of the nice nurses out there, and I did not mean to offend you, but there are people on here that say things that should probably not be seen by everyone. When I'm a patient in the ER I try to be calm and easy going also, I know what emergency means, I've been trained to know what it means as have you. The people that come in thinking they are dying because they have a bad stomach ache haven't been trained to know what an emergency is and to them, they really do think it's an emergency. It's tough when your job has to revolve around something that can be someones opinion.

As for the fact that emergency rooms are for emergencies, this is true, I know that, but where I live at 2 in the morning when you have a severe migraine where are you suppose to go? We don't have urgent care facilities, the only option is the emergency room.

Specializes in Critical Care.
sugar9486 said:
kstockdalern: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.

Please reread her post. She said she didn't know what each pill costs, but she does know what they do, what their side effects are, and why you need them.

tvccrn said:
Please reread her post. She said she didn't know what each pill costs, but she DOES know what they do, what their side effects are, and why you need them.

OMG I am so sorry. Some of things that were posted on here were just outright wrong, but this as I have been shown was not one of them... I am sorry to the original poster!! I'll be more careful next time!!

Specializes in ER, ICU, Infusion, peds, informatics.
sugar9486 said:

I am not speaking about the nurses who treat every patient the same way... As i said before i have been to many hospitals in my area and many of the nurses are rude and nasty. 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 people that come in thinking they are dying because they have a bad stomach ache haven't been trained to know what an emergency is and to them, they really do think it's an emergency. It's tough when your job has to revolve around something that can be someones opinion.

As for the fact that emergency rooms are for emergencies, this is true, i know that, but where i live at 2 in the morning when you have a severe migraine where are you suppose to go? We don't have urgent care facilities, the only option is the emergency room.

Wow, sounds like you have had some very bad experiences as a patient. Not all nurses are like that.

No, not everyone is trained in what an emergency is. But we are. And if you aren't having an emergency, you are probably going to wait. We get very irritated when we get harassed from people in the waiting room because they don't like how they have been triaged. (meaning they were told they would have to wait, that they aren't going straight to the back). If your vs are stable, you aren't bleeding profusely, you aren't having a seizure and you can breathe well enough to yell at me at the top of your lungs, you can probably wait. Like most people, being yelled out loudly and often brings out the worst in us.

Again, as we keep saying over and over.....we use this site (and this thread) as a tool to vent our frustrations. Like nurseerica (and probably the vast number of nurses that post on this site) i try very hard to treat each and every patient of mine the same: with a smile and a positive attitude. I try to educate them as to what an emergency is, and why they had to wait in a gentle way.

And, for the record, we know that you can't go to your doctor's office at 2am for migraines/stitches/broken bones. We expect to get those visits (though you may have to wait.....:) ) again, our big complaints are the things that can wait.....or really don't need to be seen at all (like everyone's favorite visit, the pregnancy test request).

Specializes in Emergency Room.

"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"

My response..................if more er patients were more polite and kind to their NURSES, maybe there would be more nurses in the field. I think that a lot of the nursing shortage is because NURSES see how patients act towards them...............:smiley_ab

Specializes in Emergency Room.

oh, my other comment............

Do you know the difference between an experienced ER nurse and a bulldog?

lipstick.:lol2:

Specializes in Emergency.
LeahJet said:
~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.....:)

Yes, I am surprised it lasted as long as it did though, before one of the people who would DO the things we are talking about found this thread.

Let's all dance around merrily and save the world now because we are only here to please, so walk all over us general public, and we will smile and get you another blanket while the baby in the next room just stopped breathing, but I don't have time for that, your poor little feet are cold!

Specializes in ED, ICU, Heme/Onc.

Angels of mercy, wiping the fevered brow (and behinds) of all that ask for it? All kidding aside, I have nothing but the utmost respect and awe for how quickly ER nurses have to think and act, multitask - all while being harassed by people walking in off the street who have "unmet needs" of all kinds. I think that humor (even of the so-called mean kind) between colleagues in a safe environment (such as an anonymous message board FOR nurses) can help blow off a lot of steam.

On the units, we get a lot less foot traffic because the ER nurses have done the weeding for us. We get the ones that are truly in need of a bed - even if they aren't the nicest people.

I've gone down to the ER on a few busy weekend nights to help facilitate a transfer of a bone marrow transplant patient or access an infusaport for someone who has never done one and there are five traumas coming in and there is no time to grab a coworker who has done one. The chaos and the noise level at 0300 was staggering and made me thankful for my tiny BMT unit.

Thanks to all of you - and I laughed my head off at these. Officer O'Myacin comes home with similar stories of "the hoarde of the great unwashed".

Blee