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.

[weirdRN, RN]

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.....:)

Yup... You are right. I will be unsubscribing...

[Rio, 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.

This was such a great thread to read and laugh and remember how I voted with my feet !

Now I'm being sucked into the swirling vortex of hopeless despair....

In the good ol' USA we are gaurentteed by LAW a Medical Screening Exam at the EMERGENCY department. THe purpose of which is to determine IF an actual EMERGENT condition exists. IF an ACTUAL EMERGENT condition is presenting, it is the law.. ES LA LEY... to treat, stabilize and/or transfer to an appropriate facility as to the best of our ability. Everything else is gravy.:wakeneo:

[ItsyBitsySpider, BSN, RN]

Sugar9486 said:

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.

Sugars discharge instructions: Please spend one month in the ER working as an RN. Return to this thread after that month and read again with a new viewpoint.

Seriously...

[BabyRN2Be]

*sigh* I agree with LeahJet and the others. This thread was really fun and I had some really good laughs. For the ED nurses who are out on the front lines and see all sorts of things that may never be seen on the floors, we salute you.

Thank you for your venting. You all need to do it SOMEWHERE. It's too bad that some people don't understand that this is a safe place to vent, with co-workers who understand and others who want a good laugh.

For those of you who don't understand, consider this: when you watch TV at home and you don't like the program, don't you turn the channel? If you don't like what you read, please visit another thread that may be to your liking. Please don't judge until you've worked in the ED (read: not visited the ED as a patient) and seen what they put up with on a day-to-day basis.

The previous poster had some really great advice. I challenge you to try it and you will gain a new view. Seriously.

[luckylucyrn]

erdiane said:

"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

Agreed! While I am never rude/demeaning to any patient, I have many patients that are rude/demeaning to me. I treat my patients the same, but as learned while we took the NCLEX, prioritizing is key in nursing, and getting someone a blanket or a snack pack is low on my priortiy list when I have another patient who needs blood or is having an MI. :sofahider

Also, about discharges: In my opinion my patient waiting to be discharged is my most stable patient, so I will get to my discharge when I can, but I have to see new paitents who may not be stable FIRST. When I am able, I will discharge you.

[casi, ASN, RN]

sugar9486 said:

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.

most er nurses i have run into through my experiences of being a patient aren't rude, they are just blunt.

thank you to the er nurses for all the unpleasentries you put up with! and thank you for sharing your stories of human stupidity through your posts and rants! i enjoy reading these.

[Sugar9486]

Okay guys you've totally got the wrong idea! I think ER nurses are great, they deal with all the patients that need help, and the ones who really don't. All I'm saying is that in my experience if the ER nurses were a little kinder and caring then they might not have as many problems with "trouble" patients. I am just asking you to think about the fact that we are trained to know what an emergency is, while the patients that come in are not. They think that the situation they are in is an emergency.

[caroladybelle, BSN, 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.

I hate to tell you, but there will always be an ER but there may not always be ER nurses. They merely wish that everyone that came in was someone that belonged there. And no, it should not ANY nurse's job to "just suck it up".

And, no, it is not the place for the nonemergently ill homeless, drug abusers and alcoholics. There are much safer and better cared for at the many agencies that specialize in caring for those groups.

People have told nurses to "suck it up" or quit...that they are quitting in droves. And a large number of those in Nursing school are looking for the short track to biggest dollars, easiest, less messy positions, or quickest route to CRNA. Which means little longterm staff for the ER. Which means longer waits, ruder staff, and less "caring" than ever. Because there are limits to what anyone can and should take in pursuing good customer service.

People ain't exactly waiting in line for any nurse's job.

I have nearly been killed due to a failing of the ER. I was prescribed a med that I was highly allergic to and was brought back in in anaphylactic shock.. Of course, if I had seen my MD in a timely matter, I would have not needed to present to an unknown, overworked foreign MD (the only MDs that will work in the Boonies, it seems). There are plenty of those ER cases that could be easily handled if insured (I wasn't) people would go to the MD when the early signs are present, but refuse to do so because "it would take too much time", " I can't miss work". The care in the ER would be much better if they weren't having to handle some much of the bloomin' trivial. If Dr (foreign name w/no vowels) wasn't dealing with the repeated pancreatitis BAL of 340, he would have paid more attention to my allergy.

Did I sue the ER...no, though I could have. Nor have I ever sued/abused any number of healthcare workers that have given me incorrect prescriptions, or prescribed the same med. Because I took control of my health care to prevent problems in the future, prior to becoming a nurse.

The public has increasingly been taught to behave badly to get quicker/better service. We take extra care of the ones that gripe the most and we reward those that do not work and take care of themselves. And the patients that most need our care get the least attention because they are unable to behave badly. Invariably the sickiest are the ones that call us the least and get the least attention.

I am an onco nurse. All the way through this thread, I could have posted all sorts of things. About how chemo patients are told often not to take tylenol until being seen, etc. But this was a vent and that would not be appropriate. I have had my own problems with ERs and do not believe that they are saints beyond all reproach (The PIA patient that ER gripes about for their 3-8 hour stay, goes to medsurg to wreck havoc for days/weeks/monthes...now those nurses have it rough). But it does not change the fact that the ER is badly abused in this country and we all should be finding a way to stop this abuse. Before no one is willing to ever work this essential job.

I too am tired of the repeat pancreatitis that goes on a bender, comes to floor and lies screaming bloody murder in the hall because the MD refuses to order 150-200mg demerol Q3h (because "nothing" else will work"), pulls out all of his tubes, fakes a few seizures trying to get sedatives, meanwhile I am taking care of a dying breast cancer patient, whose bones path fracture when we even turn her to prevent bedsores. Who now can't sleep because pancreatitis boy is screaming and has the nerve to chase me down the hall (in hooorrribbbble pain, of course) and follow me into her room.

And I don't even work the ER.

You don't like how mean they are, fine. But don't ask them to just "suck it up"

[Sugar9486]

caroladybelle said:

I hate to tell you, but there will always be an ER but there may not always be ER nurses. They merely wish that everyone that came in was someone that belonged there. And no, it should not ANY nurse's job to "just suck it up".

And, no, it is not the place for the nonemergently ill homeless, drug abusers and alcoholics. There are much safer and better cared for at the many agencies that specialize in caring for those groups.

People have told nurses to "suck it up" or quit...that they are quitting in droves. And a large number of those in Nursing school are looking for the short track to biggest dollars, easiest, less messy positions, or quickest route to CRNA. Which means little longterm staff for the ER. Which means longer waits, ruder staff, and less "caring" than ever. Because there are limits to what anyone can and should take in pursuing good customer service.

People ain't exactly waiting in line for any nurse's job.

I have nearly been killed due to a failing of the ER. I was prescribed a med that I was highly allergic to and was brought back in in anaphylactic shock.. Of course, if I had seen my MD in a timely matter, I would have not needed to present to an unknown, overworked foreign MD (the only MDs that will work in the Boonies, it seems). There are plenty of those ER cases that could be easily handled if insured (I wasn't) people would go to the MD when the early signs are present, but refuse to do so because "it would take too much time", " I can't miss work". The care in the ER would be much better if they weren't having to handle some much of the bloomin' trivial. If Dr (foreign name w/no vowels) wasn't dealing with the repeated pancreatitis BAL of 340, he would have paid more attention to my allergy.

Did I sue the ER...no, though I could have. Nor have I ever sued/abused any number of healthcare workers that have given me incorrect prescriptions, or prescribed the same med. Because I took control of my health care to prevent problems in the future, prior to becoming a nurse.

The public has increasingly been taught to behave badly to get quicker/better service. We take extra care of the ones that gripe the most and we reward those that do not work and take care of themselves. And the patients that most need our care get the least attention because they are unable to behave badly. Invariably the sickiest are the ones that call us the least and get the least attention.

I am an onco nurse. All the way through this thread, I could have posted all sorts of things. About how chemo patients are told often not to take tylenol until being seen, etc. But this was a vent and that would not be appropriate. I have had my own problems with ERs and do not believe that they are saints beyond all reproach (The PIA patient that ER gripes about for their 3-8 hour stay, goes to medsurg to wreck havoc for days/weeks/monthes...now those nurses have it rough). But it does not change the fact that the ER is badly abused in this country and we all should be finding a way to stop this abuse. Before no one is willing to ever work this essential job.

I too am tired of the repeat pancreatitis that goes on a bender, comes to floor and lies screaming bloody murder in the hall because the MD refuses to order 150-200mg demerol Q3h (because "nothing" else will work"), pulls out all of his tubes, fakes a few seizures trying to get sedatives, meanwhile I am taking care of a dying breast cancer patient, whose bones path fracture when we even turn her to prevent bedsores. Who now can't sleep because pancreatitis boy is screaming and has the nerve to chase me down the hall (in hooorrribbbble pain, of course) and follow me into her room.

And I don't even work the ER.

You don't like how mean they are, fine. But don't ask them to just "suck it up"

If you live in an area with no urgent care centers where are the people who don't have a PCP or don't have insurance suppose to go. People go to the ER because they need help, not because they want to make the nurses mad because that nurse doesn't think that they are ill enough to be in the ER. I totally argree with rosieseattle. The ER is a place for people from all walks of life. Just because the nurses feel that the nonemergent case should wait does not mean that all people agree with them. If we lived in a society where health care was free and no one needed to pay for it, then yes there would be less people in the ER day in and day out, but until that happens (Which doesn't look like it's going to happen any time soon) we're just going to have to deal with people coming to the ER because the person doesn't have insurance or doesn't have a PCP.

[StNeotser, ASN, RN]

Sugar9486 said:

Just because the nurses feel that the nonemergent case should wait does not mean that all people agree with them.

I think though it's not because they like to keep people waiting, as opposed to the fact they have to keep people waiting because higher priorities come through the door.

I realize that the nurses on this thread were merely having a vent. I don't even work in ER and yet can empathise with some of these vents.

[Ruby Vee, BSN]

kiyatylese said:

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

You are not an RN yet. therefore you don't get it. understand that you don't get it, and don't post to a vent thread calling the venters "mean."

[Pixiesmom, BSN, RN]

While I am not a nurse...yet. Hats off to you that work in the ER where as Forrest Gump would say, "Life (ER) is like a box of chocolates, you never know what your going to get."

I've throroughly enjoyed reading this thread and to anyone that has issues try walking a shift in their shoes.