1. Please fill out the triage form completely. We specially like it when you fill out the part that says "reason for coming to the hospital" as it prevents us from having to use our magical ESP powers to determine if you have chest pain or just a hangnail.
2. Do not disturb the triage nurse while she is with a patient. She is giving the patient her full attention. When you get into triage, YOU will get her full attention. Wait your turn.
3. Unless you are on fire or in full arrest, you can wait just three seconds for the triage nurse to acknowledge you before you start shouting at her. Believe me, if you shout at her near the end of a difficult twelve hour shift, she is liable to shout back.
4. After you have been triaged, please take a seat in the lobby and do not come to the triage desk every five minutes asking "When am I going to see the doctor?" Like we told you the first time, you'll see a doctor AS SOON AS POSSIBLE. No, we don't know exactly how long that will be.
Rules for the treatment area
1. Answer the nurses' questions honestly and completely. If you lie we WILL find out.
2.Do not go to the nurses' desk every five minutes asking how long it will be before the doctor sees you. We don't know. Again, unless you are on fire or in full arrest, please accept that there are probably patients in the ER who are sicker than you. Yes, I know you FEEL like the sickest patient in the ER; so does everyone else. However, the nice gentleman down the hall with a Sat of 70% trumps your earache.
3. Do not act like it's the end of the world when I tell ou I need to draw some blood. You knew it was coming. If you will sit still and follow my instructions, I will get the blood with a minimum of pain and difficulty. If I have to chase you across the room and hold you down, there will be no such guarantee. Nobobdy likes having blood drawn (inclucing me) but it's a fact of life that sometimes it has to happen.
4. I'm sorry that you have to stay on a stretcher in the hall. I wouldn't like it either. However, all of our rooms are full. The only other option is for you to continue waiting in the lobby. Your call.
5. Family members, please do not assume that I am going to abuse mawmaw if you leave the room. If I ask you to step outside while I draw blood or place a foley, please do not get all huffy about it. The rooms are small and you are in my way. Don't take it personally. I promise not to smother your loved one with a pillow while you are gone. The nursing staff is not your enemy.
6. If you have a complaint of abdominal pain, nausea, and vomiting, you may not have anything to eat or drink. So don't ask.
7. Lastly, please remember that we nurses are only human. You can look around and see when we are very busy. Please take that into consideration. If we forget to bring you that extra warm blanket or another glass of water, don't blow a fuse. Please just assume that maybe we were busy saving a life next door.
* * * * * * * * * * * * * * *
Please tell me I'm not the only one who has felt this way from time to time!
Wow, three pages:eek: . My rules are half joke, half response to a hellacious three days in the ED. It just seemed better to blow off a little steam here by making a joke than to have a meltdown at work. Sometimes you have to laugh or cry, and I'd rather laugh.
I think the frustration that I (and a lot of other ER nurses) stems not from the idea that the "stupid public" is there simply to annoy us, but from the utter lack of common sense and compassion that some people show. I certainly don't expect the general public to ALWAYS know what is a true emergency and what can wait; that's why they have us. Half the time they are in the ER because their doctor told them to come there instead of to the office (that's a whole 'nother rant!) But. . . well, here's a true life example from LAST NIGHT. The ER was a packed house with high acuity and no end in sight. We were working on three ODs (all awake and combative), several chest pains, a stroke, and a "needs to be dialyzed yesterday". A patient with a headache x 2-3 days eventually gets back to an exam room. She waits a few minutes, then starts pitching a fit about the wait. Her exact words? "I'm going to report ya'll! You brought CHEST PAINS and people who were BLEEDING back here before me, and I've had this headache for TWO DAYS!" That's the kind of stuff we hear all the time, and it's a fact of life that the patients who complain the loudest are usually the least acute.
I think I can safely speak for most of the ER nurses here when I say that we aren't burned out or mean, and we don't lack compassion for our patients -- even the ones who aren't real emergencies. We just get worn out from bearing the brunt of the publics' complaint. Nine times out of ten they don't get cranky with the doctor and they don't bother to go to admin, they just take out their frustration on the nearest person at hand -- their nurse. Nurses in every area have their own set of problems; my "rules" address some of ours.
Anyways, don't think I'm some kind of Nurse Ratched. I love my job and I like most of my patients. I just need a day off!
How about calling an ambulance for a pimple? I kid you not. And of course, once an ambo is called they have to take the person, no matter how frivolous.
A three am hangnail.
Hip pain for 1 year. Pain rating, 2/10. What changed that made it an emergency? Nothing. It was exactly one year since it started.
And the always popular: "I've been waiting six hours. I could have made an appointment with my own doctor by now." Yes, and you should have.
Years ago, insurance companies could refuse to pay for ER visits that were not true emergencies. That included viral infections, pregnancy tests, and toothaches.
Now, of course, I'd rather see someone come in with chest pain and have it turn out to be gas. But there is a line, that when crossed, common sense flies out the window.
1. Don't stand at the nurse's desk asking if we're working on your dismissal instructions...it's distracting and it violates the other patient's privacy to have you leaning over the desk trying to see what we are doing.
I definitely would have any person c/o CP to come to the ER, no matter what it turned out to be! If my mom had come to the ER, she might be still alive today!
I can see why you would take Pam's post this way, but unless you have ever worked in the ER, its hard to understand. When we come in and take report for 5 patients who are all sick with real problems (not earaches and sore throats), and then we are recieving new patients and notifications on top of that, you are already overwhelmed. Than to top it all off, you get someone that comes in for something that could have waited until the clinic opened in the morning, or because they know if they come to the ER they dont have to pay for the Rx. Working up this patient takes up a lot of your precious time, and you are spending less time with the patients that really need your observation. You know that the MD is not getting to this patient anytime soon, so now you keep adding up the # of patients you are getting. Before you know it, you have 13 patients, many of them are there for BS reasons. Now you spend more and more time documenting, drawing blood, ect on these patients that dont need to be there. This is the part that is frustrating. JMO
Ditto, ditto, ditto. I applaud the ability of the nurses on this thread to address their frustration not with hostility and rudeness, but with humor and an obvious desire to vent to someone other than the patients. Well said, y'all!
My favorite pt of all time was the man who came in during the day, in a business suit, to be treated for a problem that had persisted for SEVEN YEARS. It was, of course, a Monday, our busiest, and when I finished triaging this man, he asked me, "How long will the wait be?" I was proud of myself for NOT saying, "A h*ll of a lot less than seven years, Einstein."
One rule I'd like to see posted:
Dear Ambulatory Patients, please remember, when you want to scream, rant, complain, and resist me when I try to help you, that YOU CAME TO ME. Regardless of who advised you to, YOU made the choice to leave your home and TV and come here.
I chose this job and I love it, so I won't complain about it. I'll just say that since taking it, I have encountered a mind-boggling number of people with no common sense, no understanding of sick-sicker-sickest, and absolutely no shame about abusing state funds for free Tylenol and pregnancy tests.
The ER forum is a place where other ER nurses can support one another and be validated. This is not the place for people to judge others, especially people who are not nurses and don't work in the real world.
Sorry, did not realize the format of the ER nurse forum. My apologizes to all. I was just viewing things from a public point of view and a bad experience involving a tia. It was not my intent to trash ER nurses, rather an attempt to bring up another side of the coin. Guess I will stick to LTC where I have some knowledge and experience and work as an LPN.
i will never forget the night ,when I was at triage, that a woman came in complaining of wrist pain. She had fallen while skiing and had driven the hour or so off the mt to come to our ER. She was in pain and the wrist was obviously fractured. As I was triaging her, the secretary said, "UMmm I think you need to see this guy now!" Middle aged, SOB, diaphoretic had that wonderful gray cast to his skin c/o chest pain..I hustled the wrist out of the triage cubicle, got the guy in and called a cardiac alert. The team came and grabbed him and the gal was wheeled back in, I resumed taking her hx and vitals then "I think you need to get this one back" Teenager, swollen face , lips SOB stating she ate at a resturant and yes she was allergic to peanuts..so once again the wrist was moved out of the cubicle I started the IV on the allergic rxn while the team ran out to get her. Again I brought the gal back in and guess what???!! that is right..here come grandpa running carrying the little grandchild with a fx of the humerus which is protuding through the skin..this again is MORE of an emergency than the wrist..so guess what?? Once again she is moved out so I can get info. Each time she was moved out she carried on and on and I KNOW she was in pain but I also KNOW that none of those patients could wait...I finally stuck my head out and told her, with all due respect mam you drove for an hour down the mt to get here. I realize you are in pain and I am sorry but this is my job...TRIAGE!! That means I have the first responsibility to decide who NEEDS IMMEDiate care" She started swearing and throwing a fit. I finally got her back and under c sedation her wrist was pulled back into place and casted. On her way out she apologized to me and I to her but if I had to do it again, I wouldn't change a thing. Of course all of the headaches were complaining right along with her but I just got used to that. Our ED docs pretty much banded together to stop giving out narcs to frequent flyers..so then they would come in with abdominal pain...of course that is about a 5 hr work up and if you are female even longer than that. I also saw people use the abdominal pain thing to get a preg test...hmmm blood work, urine, pelvic, CT of the belly and that is all they wanted...Talk about an expensive PG test of course like someone else said..they were always self pay which means they didn't pay which could be why I have to pay 700.00 month to insure my family..someone has to pay for it, right?
Y'know, Erin, that's the hardest thing about ER, especially triage -- sometimes even patients who are obviously sick or in pain have to wait, because other, more acute patients arrive at the same time. There's just no way to make someone understand even real, true pain sometimes gets preempted, and I know it's frustrating for them. I just wish that the patients realized that, believe it or not, it's frustrating for us, too! Not because of the number of patients waiting or even the constant stream of interruptions, but because we, as nurses, hate to see anyone in distress.
And Todd, don't sweat it. We ER folk like having this forum because we can vent a little before going to work and putting on our "game face". We tend to cope by using dark humor and sarcasm, but most of us work hard to keep our frustrations to ourselves so the patients don't see it. I'm whining here on the boards, but yesterday at work I was making Sesame Street jokes with my eighty year old patient and his family. It's nice to have a place to go where you can be reminded that you aren't the only one to ever feel a certain way, that the frustrations are the same in every ER in the world, and someone out there in cyberspace knows what you go through every day. And it's good to have people who can help you keep your perspective, and gently remind you why you do this crazy job, or even chide you a little when you're out of line. It's difficult to explain to folks who've never experienced it first hand, just as I would probably have a hard time relating to the unique challenges that face nurses in an LTC setting, or in an ICU, or on a Psych ward. I know that sounds cliche, but it's true.
Ditto, ditto, ditto. I applaud the ability of the nurses on this thread to address their frustration not with hostility and rudeness, but with humor and an obvious desire to vent to someone other than the patients. Well said, y'all!
My favorite pt of all time was the man who came in during the day, in a business suit, to be treated for a problem that had persisted for SEVEN YEARS. It was, of course, a Monday, our busiest, and when I finished triaging this man, he asked me, "How long will the wait be?" I was proud of myself for NOT saying, "A h*ll of a lot less than seven years, Einstein."
It's stuff like the above, that makes it reaal hard for me to keep a straight face!:chuckle!
Worked in an ER in small town in S. C., where the nearest OB was about 70 miles away. And you guessed it, ....was a running deal to have someone wait until the last min to come in, and deliver! And you just hope you have a decent locum working with you!
Please tell me I'm not the only one who has felt this way from time to time!
It was, of course, a Monday, our busiest, and when I finished triaging this man, he asked me, "How long will the wait be?" I was proud of myself for NOT saying, "A h*ll of a lot less than seven years, Einstein."
V. Nightingale
51 Posts
Wow, three pages:eek: . My rules are half joke, half response to a hellacious three days in the ED. It just seemed better to blow off a little steam here by making a joke than to have a meltdown at work. Sometimes you have to laugh or cry, and I'd rather laugh.
I think the frustration that I (and a lot of other ER nurses) stems not from the idea that the "stupid public" is there simply to annoy us, but from the utter lack of common sense and compassion that some people show. I certainly don't expect the general public to ALWAYS know what is a true emergency and what can wait; that's why they have us. Half the time they are in the ER because their doctor told them to come there instead of to the office (that's a whole 'nother rant!) But. . . well, here's a true life example from LAST NIGHT. The ER was a packed house with high acuity and no end in sight. We were working on three ODs (all awake and combative), several chest pains, a stroke, and a "needs to be dialyzed yesterday". A patient with a headache x 2-3 days eventually gets back to an exam room. She waits a few minutes, then starts pitching a fit about the wait. Her exact words? "I'm going to report ya'll! You brought CHEST PAINS and people who were BLEEDING back here before me, and I've had this headache for TWO DAYS!" That's the kind of stuff we hear all the time, and it's a fact of life that the patients who complain the loudest are usually the least acute.
I think I can safely speak for most of the ER nurses here when I say that we aren't burned out or mean, and we don't lack compassion for our patients -- even the ones who aren't real emergencies. We just get worn out from bearing the brunt of the publics' complaint. Nine times out of ten they don't get cranky with the doctor and they don't bother to go to admin, they just take out their frustration on the nearest person at hand -- their nurse. Nurses in every area have their own set of problems; my "rules" address some of ours.
Anyways, don't think I'm some kind of Nurse Ratched. I love my job and I like most of my patients. I just need a day off!