Whats the worst thing you can say to the nurse in an emergency room?

This and other questions are answered in an informal survey of doctors, nurses and paramedics,
who offer their own insights into the inner workings of hospital emergency rooms. Every year,
the nations emergency rooms treat 117 million patients, and the average patient spends nearly
three hours in the E.R.

But what really goes on behind the scenes? The magazine Readers Digest quizzed emergency
health workers about the quirks and peeves of the E.R. Here is some of what they had to say.

1. The busiest time starts around 6 p.m.; Mondays are the worst. Were slowest from 3
a.m. to 9 a.m. If you have a choice, come early in the morning. Denise King, R.N.,
Riverside, Calif.
2. People who are vomiting their guts out get a room more quickly. The admitting clerks
dont like vomit in the waiting area. Joan Somes, R.N., St. Paul, Minn.
3. Never tell an E.R. nurse, All I have is this cut on my finger. Why cant someone just
look at it? That just shows you have no idea how the E.R. actually works. Dana
Hawkins, R.N., Tulsa, Okla.
4. Dont blame E.R. overcrowding on the uninsured. They account for 17 percent of visits.
The underlying problem is hospital overcrowding in general. Leora Horwitz, M.D.,
assistant professor, Yale University School of Medicine, New Haven, Conn.
5. Never, ever lie to your E.R. nurse. Their B.S. detectors are excellent, and you lose all
credibility when you lie. Allen Roberts, M.D.
6. We hear all kinds of weird stuff. I had a woman who came in at 3 a.m. and said shed
passed out while she was asleep. Emergency physician, suburban Northeast
7. Your complaints about your prior doctor will not endear you to us. The more you say,
the less we want to deal with you. Allen Roberts, M.D.

To hear all 50 insights from the emergency room, read both articles from Readers Digest, 15
Secrets the E.R. Staff Wont Tell You, and 35 More Secrets the E.R. Staff Wont Tell You.
And then please join the discussion below.

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Allan Lang February 18, 2010 3:54 pm

A very busy Hospital and a busier ER can combine, as they did for me, into a five + hour wait
without being able to talk
to a medical doctor.

hen3ry February 18, 2010 3:55 pm

Most of the time Ive found the ER staff to be courteous when dealing with people who are in a
bad state mentally or physically. This may be because my experiences occurred when the ER
was not busy. But I have to say that I was treated well, promptly, and appropriately. Even when I
was not in a state to understand what they wanted the ER personnel were polite and insistent but
not rude. No one likes being hurt more when they are hurting already but the apologies and
explanations given to me when I was not able to cooperate because I was so sick were
appreciated.

To all ER staff, never underestimate the effect of your apology and explanation for why you are
causing pain on the patient. Even if we are unconscious or unable to respond, it probably helps.

John Schumann, M.D. February 18, 2010 4:07 pm

These are indeed great secrets. Ive tried to share a few more, in addition to giving lay readers
some insight about what goes on in a couple of my blog posts:

http://glasshospital.com/2010/01/06/emergency/

and another here:

http://glasshospital.com/2010/01/07/the-mystic-portal-awaits/

lastly:

http://glasshospital.com/2010/01/14/un-maligning-the-er/

I hope you enjoy. Im keen on demystifying hospital life for readers.

Dr. John a.k.a. GlassHospital

Paula C February 18, 2010 4:11 pm

Those are absolutely terrible articles. They seem to only reinforce the perception that you should
sit down and shut up and well get to you when we get to you. Nothing even remotely useful
there. Have your accident when were not busy. Vomit as much as possible for the best
service. Were not interested in your little cut, well stitch it if we feel like it. ER workers did
themselves no favors by letting their bad attitudes get put in print.

Michael in Kenwood February 18, 2010 4:13 pm

Two things that are VERY important to say to an ER nurse: Please and, thank you.

megan February 18, 2010 4:34 pm

One thing I cant emphasize enough: the ER is not the place for a family reunion. Bring one
responsible adult to help you through the process. If you must bring children, see that there is an
adult to watch them. We are not Romper Room. We need to figure out whats wrong with you
and treat you. We dont really want to deal with your sisters, best friends, and boyfriends
sisters hysterics at the same time. Please leave the entourage at home.

rach February 18, 2010 4:40 pm

Be nice to the security people often theyre the only ones with time to get you a drink, help you
to the bathroom or get a nurse.

as February 18, 2010 4:50 pm

Be nice to your ER nurse or doctor. Dont be nasty. Nastiness is not in your best interest. Trust
me on this.

Alex Lickerman, M.D. February 18, 2010 5:08 pm

So frustrating how crowded ERs have become. The root cause is overuse by patients whove
figured out they can get seen sooner (even after 10+ hour waits!) than getting to see their primary
care doctorif they even have one. No one part of our medical system exists in isolation. Like a
long line of proverbial dominoes, when one part tips over, it knocks down almost all the others in
some way.

M.B. February 18, 2010 5:19 pm

I was once sent to the ER (by my doctor) for what was suspected to be a kidney infection. The
on-call doctor, a rather rough-around-the-edges young resident, was weirdly chatty and
mentioned that he estimated that about 75% of the patients he saw were just there to get
narcotics. Then he proceeded to write me a prescription for Vicodin for what later turned out to
be an inflamed stomach lining. Weird

SMA February 18, 2010 5:43 pm

Be nice to your ER nurse or doctor. Dont be nasty. Nastiness is not in your best interest. Trust
me on this.

Do you mean that healthy ER employees get even with the sick or injured? Disgusting!

helen February 18, 2010 5:44 pm

I think I have seen it all in the ER. But one thing for sure, in 1997, my husband had a stroke. He
was taken to a busy NYC ER and given very prompt curteous attention. There was no question
his problem was a top priority. The ER can be a nasty place but I like to think that when it really
counts, the ER will function appropriately.

Greg February 18, 2010 5:47 pm

One tip is to be honest yet civil with the ER nurses. Emergency physicians are especially reliant
on their nursing colleagues for updates and informationchances are before the doctor does get
to you, he/she has had a thorough discussion of your case with the nursing staff.

CB February 18, 2010 6:00 pm

Megan (#6), I understand your comment about hysterical adults, and not having to deal with that,
but the Romper Room comment fries me just a tad. Have you ever tried to find a sitter at 3 a.m.?
For single parents, especially, there are many times when you just have to bring children with
you. If youre in the ER because youve been incapacitated in some way, you cant exactly run
after them yourself.

Most hospitals have patient advocates. I suggest they take a look at their rules on children, and
see how those may affect single parents.

adc February 18, 2010 6:07 pm

I spent a day observing on an ambulance earlier this week, in a big urban area with limited
ambulance coverage. Here are some of the calls we got during the day (obviously not actual
quotes, but close enough). Mind you, these went out as emergencies we were lights and sirens
for this crap:

1. I fell. I didnt lose consciousness. Im not sure if I need to go to the hospital. I dont think Im
hurt.
2. I need my blood pressure checked. I feel like its high.
3. Repeat 1
4. Ive been having chest pain for two months.
5. I have thrown up twice today.

Ive also seen the opposite occur do not, please, drive yourself to the hospital if a baby is
imminently dropping into your pants.

With that limited experience in mind, I would say that I, for one, will be thinking VERY
carefully in the future about when to call 911, and when to simply ask someone to drive me.
Whenever you have someone right there to drive you, its usually faster and always cheaper.

Use the system when you need it. But at least consider whether you do, in fact, NEED it.

Susan February 18, 2010 6:32 pm

One thing Ive learned in all the cities I lived in if its minor (cut, twist, etc.), go to urgent
care or a small hospital ER. If its major (chest pain, unconciousness, etc.), go to an ER. You will
get treated much more quickly when you do so and if you need treatment that the place you are
cant give, youll get transferred.
Also, be courteous to everyone else in the waiting room; they dont want to be there any more
than you do. If youve got a kid, keep them quiet for the guy curled up with a migraine. If you
hurt, dont assume you hurt more than anyone else.

Linda February 18, 2010 6:44 pm

Keep all your medical information together such as the names of your medications and
conditions you have, allergies, etc. Keep it where you can find it in seconds. Then you can just
hand it to the EMT or the emergency room nurse. Better yet, get what is called a Vial of LIfe. All
the information goes into a bag or vial that hangs on your fridge door. Then a sign goes on the
front door saying you have a vial of life. The EMT personnel know where to find your
information.
Sometimes people arent lying to the emergency room personnel. If your are really hurting or
have memory loss you may not give the right answers. My dad cant remember that he has
diabetes or what medication he is on. I keep it all on paper for the medical personnel.

mdri February 18, 2010 6:54 pm

I second the comment that ER patients should try to treat the ER staff with respect. We are
professionals and will do our best to treat you with compassion and respect, but we are only
humanif you yell and curse at us or are otherwise difficult to interact with it can become
difficult for us to act in your interest without negative emotions influencing our decisions. Of
course there are bad eggs in any workplace, but no ER tech, nurse, doc etc I have ever worked
with has purposely neglected or punished a patient for being difficult. But medicine is an art
and much decision making is not black and white. To get the best care you want your providers
to be on your side and not dread having to talk to you. We do realize that patients in the ER are
often in pain and distress, and that can make the best person unpleasant, but that does not excuse
persistent rudeness and verbal (sometimes physical) assault on the ER staff.

We put up with a lotin what other work environment (other than law enforcement) is it routine
and expected to be yelled and cursed at every single day? ERs are among the worst work
environments for workplace violence. Every ER worker I know has had punches thrown at them,
been spat at, etc. I strongly feel that the overall complacency towards verbal violence in the ER
contributes towards the physical violence.

Please do what you can to control yourselfyou may get better care and you will help keep the
ER safe for everybody.

Hippo Crates February 18, 2010 7:20 pm

Something I wish Id thought of the last time I went to the ER: bring a blanket. In the winter, the
waiting room can be cold or drafty, in the summer overly air-conditioned. Couple that with
sitting in cold hard chairs for a few hours, and youre going to get pretty chilled, especially if
youre nauseated or shock-y to begin with.

Patricia MD February 18, 2010 8:28 pm

I am not an ER doctor but, as a hospitalist, spend a lot of time in the ER. Some
recommendations:

1) Presume the staff is competent. Dont treat them as if they arent.

2) Choose your ER. If I were having a stroke or MI, I would go to a tertiary care facility and deal
with the wait and the mayhem. If it was an injury or illness that would be treated and released,
choose your smaller, community hospital. Youll get more TLC and less waiting. The specialty
expertise at the big hospital comes at a price and usually its a long wait. The ER physicians are
usually good in both places.

3) Be as nice as you can to the staff. We will cut you slack if you feel so lousy or are so worried
that you are rough around the edges. Everybody can tell when you are upset and when you are
just a jerk. Jerks get less TLC.

4) If you have a concern, voice it. If you have a question, ask it. BUTaccept the answer.

5) If your experience is good, write a letter. Its a great feeling to know your work was
appreciated.

6) If you had a bad experience and you werent satisfied, write a letter. We cant fix a problem if
we arent aware of it.

sharon February 18, 2010 8:55 pm

If you are going to the ER because something you have been getting treatment for has become an
emergency, call your doctor after youve called 911 or before you leave for the hospital so
your doctor can call ahead and give instructions to the emergency room staff. They will be able
to take much better care of you and a lot of guesswork will be eliminated. That of course, is
assuming you are going to the hospital your doctor is affiliated with and you have a good,
responsible doctor.

PA MD February 18, 2010 10:13 pm

This kind of thinking by ED workers while all too real is demeaning to all, but mostly those
spewing it (though the busiest time part is an exception.) The rest is quasi-judgmental and
haughty on the ED staffs part.

And yes, i am an ED MD with 20+ years in.

To those reading forgive these snide things we are given an great opportunity to serve those
in need, and once in awhile we get full of ourselves (or full of something else!)

Tabby February 19, 2010 12:19 am

When I am sick, Im not going to be THE nicest person in the world. But I will be respectful.
What an ER nurse SHOULD expect is that a sick patient is not necessarily coming for sunday
afternoon tea, and that should we be cranky it comes with the package.

I remember sitting in an ER waiting room when I was 12 weeks pregnant with abdominal pain.
They wouldnt send me to their OB floor because I wasnt far enough along. They waited 2
hours before bringing me back.

By that time, my husband was sick with worry and absolutely furious. So when the non chalant
ER nurse approached us with a little attitude, my husband flipped it back and she didnt like that
at all. In fact, she went back out and started ranting about it to whoever would listen to her. I got
treated like I was a problem patient from then on.

Im laying there. pregnant, in pain for a good two hours without them doing anything about it.
The pain eased up, and when it looked like they werent going to run tests or do a sonogram or
anything.. I got up and put my clothes on and left.

I wont go to a ER unless Im certain that Im going to die. Even then, staying home sounds like
a better option with the way you get treated in the hospital these days.

Karen, RN February 19, 2010 1:04 am

I agree with PA MD (#22).

The ANA defines nursing as the protection, promotion, and optimization of health and abilities,
prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of
human response, and advocacy in the care of individuals, families, communities, and
populations.

Professional RNs have no business being rude or callous with ANY patient. Such behavior is a
sign of unprofessionalism, burnout or both.

Dr.Rajesh February 19, 2010 7:07 am

Dear All

I would suggested Two studies

wo recently released studies on ambulance diversion provide an alarming glimpse into the ability
of the countrys emergency departments (ED) to handle the ever-increasing number of patients
who are transported via ambulance to the hospital for emergency treatment. The Annals of
Emergency Medicine has published two studies that uncover the extent of ambulance diversion
as well as insights about the causes and characteristics of this growing problem.
The first study, conducted by researchers at the U.S. Centers for Disease Control and Prevention
(CDC) found nationally that about one ambulance is diverted every minute from its originally
intended emergency department. The primary reason for diversion was that the intended ED was
overcrowded and could not safely care for another sick or injured patient. That translates into a
significant number of patients. According to CDC, about 16.2 million patients arrived by
ambulance to emergency departments in 2003 (the last year for which data is available).
Nearly 40 percent of the emergency department ambulance visits were made by patients over the
age of 65. And not only were many of the emergency ambulance users older, but they were also
sicker. CDC found that nearly 70 percent had medical conditions that were classified as either
emergent or urgent and more than a third were ultimately admitted to the hospital. For these
patients, minutes can be the difference between life and death, so diversion can have devastating
consequences.
CDC found that hospital EDs cited a lack of appropriate beds (51 percent), a high number of ED
visits (50 percent) and complexity of ED cases (18 percent) as reasons for diverting ambulances.
The second study on ambulance diversion was conducted by researchers at UCLA and was
designed to assess the impact hospital closures have had. Looking at data from a seven-year
period, the researchers found that diversions at Los Angeles County hospitals more than tripled
between 1998 and 2004. In California the number of hospital emergency departments decreased
by 12 percent between 1990 and 1999 at the same time that emergency visits increased by 27
percent.
The UCLA researchers also found that county-operated hospitals spent 150 more hours on
diversion, compared with other hospitals. They also reported what they call the network effect
whereby the number of diversion hours tracked at one hospital was similar to the number of
diversion hours at nearby hospitals. This suggests when one hospital goes on diversion, area
hospitals become overwhelmed by the increase in incoming ambulances.
The research team at UCLA reached several conclusions based on their findings. First, the
increasing number of diversion hours, along with an increased network effect, suggests that ED
capacity to absorb future closures is declining. Second, emergency department overcrowding is
more likely the result of diminished ED and hospital capacity rather than increased patient
demand for emergency medical services.

https://www.journals.elsevier.com/journal-of-emergency-nursing/most-downloaded-articles