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!
I am a first semester nursing student (with ONLY 4 days left in this semester!!!!) and I work in an ER as an Admit Representative. I can totally relate with your frustration - it's frustrating for us because we get the same crap such as "How much longer...?", "Why did he/she go back to see a doctor before me? I was here first" .......well, ma'am let's see, you are hear for "back pain" (probably drug seeking) and the person who just went back was a child found in a pool unconscious........."HERE'S YOUR SIGN!!!"
The warped sense of humor is definitely needed to get through your shift and continue to work in that environment. When I first started working at the ER, I used to think that the nurses were just incompassionate or a**holes, but it didn't take me long to understand!!!!
There are still nights that I don't agree with the "treat 'em and street 'em" attitude. I definitely don't want to do ER when I graduate nursing school. But, for now, it's helping to pay the bills, keep medical insurance, and most of all, it's good education for me. We don't do an ER rotation in the nursing program that I am in, so the docs and nurses let me "observe" some things when I am not busy (which is not often!!)
So to you and athomas91, I am printing out your "rules" and passing them along tomorrow evening to my co-workers!!
Haven't had much time to laugh since August so thanks to both of you and others for your anecdotes. The last couple of weeks have been stressful, finishing clinical rotations, all the paperwork we had to turn in, pulled a couple of extra shifts for a co-worker who was sick, had a research paper due last night for A&P II, a Torso lab test last night also in A&P, an ERI test tomorrow, and finals next Monday! I am sure everyone can relate!!
Sounds like you are very good at multi-tasking and keeping up with the hectic flow of ER registration, which makes me think you would be a likely candidate for the ER upon graduation. Why would you not consider it? You are already used to the types of patients, the idea of priority management, the need to keep focused no matter who/or what is trying to sidetrack you from the task at hand. Please reconsider. You sound like a great fit for emergency nursing!
It sounds as though you are an ER nurse yourself - is that why you are advocating that field? Thanks for the compliments! In all honesty, once I complete next semester, I hope to be a Nurse Tech in the ER. I don't want to stay in Admitting; I want to get more "floor" experience. Being a nurse tech in the ER is better than a nurse tech/nursing asst. on the floor where ALL you do is wipe hineys!.
One of our current ER nurse techs is graduating nursing school next summer so her position will be freed up. I think that teching will help me make up my mind if I really want to stay in emergency medicine. I do like the "never a dull moment" atmosphere. I am just a very compassionate person. I like to get to know my pts - you can't really do that in the ER.
I really have my hopes set on pediatrics. Next semester, my class will do rotations in Peds and OB. So, again, that will help me make up my mind what I want to do once I graduate (which seems so far away right now!)
Here's a few more "rules" I came up with driving home from school today. They apply more to the admitting staff than they do to the ER nurses:
1) Please do not get mad because I ask you to fill out an information sheet. I know you don't feel good; otherwise you wouldn't have come to the ER. I really do need the information asked for, such as your name (that's the most important), time of arrival (so that the triage nurse can keep up with who arrived first), your address (yes, we do plan to send you a bill), your phone# (I'd prefer that you put one that is actually connected), etc. If your injury is to your writing hand or that side of your body, I'll be glad to fill it out for you - a "thank you" would be nice once we're done. If you are trying to handle a screaming child (for whatever reason) or several children, I'll do the same. I am a parent and I have been in an ER with a screaming child and I understand you probably can't even think of your own name right now, much less your child's.
2) Please do not throw your driver's license or picture id at me when I ask to make a copy. I do deserve a little respect. I asked for it nicely. I know you may have been here a few days ago or a week ago, or whatever. However, I do have to make a copy EVERY time you come in. Yes, we probably do have it "on file" somewhere in Medical Records, but I can't retrieve it as quickly as I can just make another copy of your id.
3) Please don't get mad as I verify your information during registration. I understand if "nothing's changed" since your last visit. However, whichever one of my co-workers registered you last time you were here may not have gotten correct information (I am sad to say) and I'd prefer to check it if you don't mind. If you are in the computer from a previous visit, it takes me about 3 minutes to get thru all the screens and verify it with you, so just indulge me.
4) For all those family members/friends who come in when a loved one is in a serious accident, or has a serious condition - when it is a child, ONLY mom and dad can go back. When it's an adult, IMMEDIATELY FAMILY ONLY and it's one visitor at a time. Aunt Sue, Cousin Bob, and Grandma, and all the rest of the clan will have to wait until the nurse tells me otherwise. I know you are concerned, I would be too. I am a mom, a wife, a daughter, a sister, a sister-in-law, a daughter-in-law, and an aunt - believe me I understand! However, hanging out at my window glaring at me won't change the rules. There is only so many people that can fit in those little ER exam rooms and the nurses/doctors and whoever need room to do their job. I'll do my best to give you updates when the nurse lets me know something. However, I do have other tasks at hand, as do the nurses.
Just some observations, too:
People who come in "sick" (especially those with SOB) who go outside and smoke. Same with parents of sick children - if they were really sick, you wouldn't leave them lying in a chair in the lobby while you smoke, or better yet, take them outside with you!
People who do go outside for whatever reason (like to smoke, or get a better signal on their cell phone) who get pissed because they don't hear their name called to be registered/or go to an exam room!! We have lots of patients and we don't have time to come looking for you. Our waiting room is inside where the chairs and TV are, not outside where the benches and cigarette receptacles are. I am moving on the next person in line if you don't come to my window by the 3rd time that I've called your name. The nurses will do the same.
People who come in needing a wheelchair AND need ASSISTANCE getting their loved one out of the car. So, how did you get them in the car in the first place?
Why do people leave in such a rush for the ER that they "forget" their purse/wallet and don't have any identification? Most of these people don't have "real" emergencies. They won't die in that extra minute that it takes to get your purse/wallet. What if you get pulled over by a policeman on the way? Or better yet, get in a wreck, and come to the ER (which was your ultimate goal anyway) and then get registered as a John/Jane Doe because no one know who the HELL you are!
WHY do people also leave in such a hurry that they don't put shoes on?? I've seen this more than once. One lady was so embarrassed and worried about "catching" something. I ended up getting her some surgical "booties" to put on. I think her little boy had cut his forehead or head or something. They just jumped in the car and headed straight for the ER. Like I said, I am a mom and I would be frightened, shaken up, or whatever. BUT, I would put some shoes on before I left.
Also, (and this is my last "rant") - WHY on earth do some people try to drive their loved ones to the hospital when it's a REAL emergency??? I've seen this twice now that I can remember and I know it happens more often. One time was a drug overdose and one time was a child found in a pool not breathing. JUST CALL 911!!! I think that the drug od person lived and the child ended up being ok but was sent to PICU for obs overnight. Don't waste those precious minutes, though!! 911 operators can walk you through what to do (like CPR - DUH!) until paramedics get there.
Hope these give someone a laugh or an "I've been there" feeling.
Only have a second, but I had to comment! Yes, I went straight to a level I trauma center upon nursing school graduation and never looked back! The hospital is located in a very poor, very urban center in Newark, NJ, but is a teaching hospital as well, associated with the state medical school; I have learned much during my ten years here. I sat for the emergency nurses certification test 2 years after nursing school graduation and have remained certified. I love emergency nursing and have seen many people come through, try it, and leave, and I'm telling you, YOU HAVE WHAT IT TAKES!!!!! There are emergency rooms that treat solely pediatrics, along with separate areas for adult emergency and traumas. You have such a unique handle on all aspects of the ER route, from registration to hanging around waiting during treatment, to discharge. C'mon. Give it some
thought! Maybe the stint as an ER tech will change your mind.!
Good Luck in whatever you do, you sound like you are going to be great in nursing!
Please don't assume that everyone coming into the ED with c/o back pain is "drug seeking".
I had to call the squad to bring my husband to the ED with back pain. He has a history of 2 herniated lumbar discs. He was turning on the water to shower and experienced severe pain: he was very diaphoretic, about to pass out, skin color extremely pale, lips turning blue, and completely unable to ambulate. He tried to walk and fell to the floor because of his pain and weakness. Physician's office not open and he needed something NOW. I had to verbalize alot of anger and beg the ED doc to call his personal physician to discuss the case, who agreed with me that he should be admitted. Took 2 days of physical therapy and IV medication to get him ambulatory again.
Also, women experiencing cardiac events often present with back pain, so don't write them off.
Don't mean to attack you, just want you to understand that back pain may be a good reason to seek immediate treatment. I do know that you see your share of drug seekers, but please don't label all "back pain" patients this way.
I feel really bad about this, since I'm not even a nurse yet, much less an ED nurse/goddess/demigod.
Nonetheless, this is MY Emergency Department Rule List...(I'm a research assistant in Peds ID/Urgent Care)
1. If you can see your child's bone, please take them to the ED.
2. If your child's leg is lying at an angle that you cannot replicate with your own leg, please take them to the ED, and not only after Thanksgiving is over.
3. If your child is HIV+ and has a fever of 103, please take them to the ED. (A little Tylenol would be nice, too).
4. If your child fell on the ground for no reason and didn't move for over a minute, it will not ruin their holiday if you take them to the ED.
5. If your child's lips are blue, it might be a good idea to see the nice folks at the ED. You may rule out punk lipstick yourself.
6. Your 16 year-old daughter might not just be having a bad tummy ache if she has also put on a surprising pot belly in the past, say, 30 weeks.
'Course, I guess #6 is easily turfed again....
BTW, except for #6, all of these called our (urban) ambulatory care clinic looking for an appointment--you know, where it takes a month or two to see a doc!
Y'all rock-- I don't care if you're an ED or L&D nurse, I kiss the ground you walk on. Just don't assume that means that if I ever make PNP I'll see your kid's screaming earache within a week's notice!
Please don't assume that everyone coming into the ED with c/o back pain is "drug seeking". "
To nursemaa,
I am SO sorry that happened to your husband I apologize to you and if I offended anyone else who may have gone to the ER for legit. back pain or taken a loved one for the same.
We do have legit. back pain pts at the ER I work at, however, most of the pts who come in for that problem do not seem legit. They could probably go home and take some Motrin and be fine the next day.
Everyone is entitled to their opinion on this web site and I was merely voicing mine. I did not take your post as an attack.
To Scis,
Thank you for the vote of confidence and kind words. I think that it takes a special personality to work in emergency medicine. I wish that there were ER's in my area that had separate parts to treat just peds. I would love that!!
My only problem with working the ER is that I have a real hard time holding my tongue at times and I'd be likely to share my "rules" (or others posted in this thread) face-to-face with some pts and lose my job!! That, or I'd get SO mad sometimes that I think I am going to have a stroke! Don't know which is worse!
It's definitely hard to leave it at work. My poor husband hears about it all. He's a great sounding board! I just can't go to bed sometimes at night when I get home until I just get it all off my chest. I'm glad for this web site as well.
It's OK, I wasn't offended, I just know that sometimes it's easy to label certain patients and I wanted to point out that there are exceptions. I should also say that the nurses were great to my husband and me, it was the physician that acted like we should just go away.... Oh well, I advocated for him and got him the care he needed, so the outcome was good. Thanks for caring!!
And you're right, many patients come to the ED unnecessarily!
Since I start my ED orienation Sun night, I want to get in one last "shot" at my old unit. I worked cardiac stepdown and had a direct admit last night> I got to the really important part: why did you come to the hospital tonight? Answer: chest pain! When did the CP start? 2-3 MONTHS ago. And are you having pain now? Yes, I'm hungry. Go get me something to eat. And this was on a night when we had very few beds in the hospital.
See, now if that direct admit had gone through the ER, they could have ruled out the cardiac dispo and the patient could have been given food and discharged! ScisRNCEN
Of course we would have also referred the patient to a cardiology clinic or PMD (I assumed they had one since they were a direct admit) to find out why they've had chest pain for 2-3 months!
In the hospitals I have worked in, no one gets directly admitted to any specialty unit without an ER workup. The beds are too scarce nowadays! Good Luck to you in the ER!
Please tell me I'm not the only one who has felt this way from time to time!
I apologize to you and if I offended anyone else who may have gone to the ER for legit. back pain or taken a loved one for the same. 
Scis
93 Posts
Sounds like you've got a group of great minds working together!
I concur with all of you. Sounds like a great plan!