I have been a registered nurse for almost 7 years and in that time I have experienced so many human interactions, I couldn’t count them if I tried. I absolutely love being a nurse and these sometimes crazy, sometimes heartbreaking, sometimes infuriating situations I find myself in regularly are exactly why emergency nursing is the place for me. Everywhere I have ever worked is unique in its own way, even down to the type of patients I get to care for. The emergency department is ever changing and keeps me on my toes which is precisely why it holds my interest and adds so much value to my career.

On the other hand, while working in the emergency departments of multiple hospitals across the United States, I have noticed some trends and behaviors that occur no matter where I am geographically located. There are things my patients and/or their family members do that drive me absolutely crazy. There are also many behind-the-curtain [if you will] things that I wish people knew when it comes to their own healthcare. The mind of an emergency department nurse is a dark humored, rapidly operating, heavily guarded yet compassionate at its core abyss that is hard to see into most times. With the help of some of my amazing coworkers, I have compiled a list of the top things that your ER nurses wish you knew.

We wish you knew…

• There is a time and a place when you should be visiting you primary care doctors office, an immediate/urgent care clinic or the emergency department. Truth be told, the emergency department is meant for EMERGENCIES…I don’t know why this is shocking to many people, but it is sort of called that for a reason. You should not be using the emergency department for your run-of-the-mill cold/cough/sore throat/burning with urination/twisted ankle etc. These types of issues should be dealt with by your primary care doctor or an urgent care provider in your area. Did you know–you can call the switchboard at the hospital your doctor is associated with and have them [or another doctor who is covering for them] paged if you need to ask a question or seek guidance? Do this through the operator, NOT by calling the emergency department…they are busy answering other phone calls and connecting you to the operator is getting in the way of the ED running smoothly. This misuse of the system is something many healthcare providers feel very passionately about. What we feel when you come to the ED without a true emergency is not annoyance that we have to take care of you. Most of us are there because we love doing just that–taking care of people. What makes us upset is that often we are trying our best to save a man having a heart attack, or a newly diagnosed diabetic kid in ketoacidosis, or a woman having a stroke, or a mother having a miscarriage, or any number of other life-threatening emergencies and you are taking up time, energy, and resources that could be dedicated to helping them. Sometimes people come to the ED thinking they are having a serious emergency and, after a giant workup, find out they are perfectly fine. THIS IS OKAY!!! If you ever feel like an emergent situation is happening or you are truly worried your life/limb/well-being is at stake, it is always appropriate to come to the ED. We are happy to take care of you but understand you may have to wait a bit while we deal with the bigger emergencies.

[Side note: Special consideration is sometimes necessary for this particular issue. In the town I currently live in, there is only one urgent care clinic and they do not accept the medical card OR the insurance that the only hospital in town provides for its employees. This often forces the emergency department to function as an urgent care clinic if patients cannot get into their primary care provider in a timely manner. This happens frequently and, as nurses, we do our best to be aware of this and understand when patients come in for non-emergent issues.]

• Please don’t come in and demand certain doctors unless it is absolutely 100% necessary. For example, a young teenage girl comes in with lower abdominal pain and may need a pelvic exam. She would prefer the female doctor on staff care for her instead of the male doctor. That makes sense, right? But if you just don’t like a certain doctor for petty reasons, no, you don’t get to pick who you get. It is SUCH an awkward position to put your nurse in to go tell a doctor that the patient asked for someone else. Yuck. Just thinking about it makes me cringe.

• Don’t be the family member that hovers over your nurse while he/she is trying to place an IV line. You are not helping anyone including your loved one by doing this. Also never ever EVER say to your nurse “Are you good at IVs?” because WE ARE ALL GOOD AT IVs. We wouldn’t be able to work in an emergency department if we weren’t. There is some weird “Murphy’s law” about this awful question that can cause the most competent and efficient nurses to be unsuccessful. Just don’t ask it. Also no, phlebotomy cannot come start your IV; they don’t do IVs. Also no again, you cannot have your IV started with a butterfly needle; those are for blood draws only.

• When you come into the emergency department with abdominal pain and immediately demand a sandwich and water, we are not being mean by not giving that to you. If there is any small chance that you could potentially be a surgical candidate, we have to keep you “NPO” which is the medical abbreviation for “nothing by mouth.” This is related to the risk of you vomiting and breathing it into your lungs (called “aspirating”) if you were to be sedated and intubated (a breathing tube temporarily placed down your throat) for surgery. Additionally, if you are being worked up as a potential stroke patient, you may not have anything to eat or drink until a swallow study is completed. This is again related to your risk of aspirating, this time due to not being able to swallow efficiently. We are not withholding food/water from you to be unkind. It is for your safety. Telling us that you haven’t drank anything all day and are so thirsty does not change that. Safety will always come before comfort. On the other hand, your nurse does have access to small sponges on a stick that can be used to moisten your mouth; ask for them and your nurse should be able to accommodate.

• We get really confused when you come into the emergency department and then get angry that the doctor wants to do blood tests/urine tests/scans/etc. Isn’t this why you came into the ED in the first place? To find out what is wrong with you? Nothing will annoy your nurse faster than acting like we walked into your home, plucked your out of it and brought you to the ED to do tests on you for fun and this is all a giant inconvenience for you. You came to us looking for care; let us help you.

• If you are the patient or the family member of a patient who cannot speak reliably for themselves, please don’t be on your cell phone when I am trying to assess and interview you. We are usually extremely busy and have a limited amount of time to be in your room before we have to run to the next task so wasting our time while you play on your phone is irritating to us. If the provider or nurse is in the room with you, turn down the TV, put down the phone and please respect our time.

• I honestly have no idea why I would need to tell an adult this but COVER YOUR MOUTH WHEN YOU COUGH!!! As a nurse, I do not possess a super-human immune system that will protect me from every germ floating around the ED (and trust me, there are tons!). I don’t want to be sick any more than you do and coughing in my face is 100% NOT appreciated.

• PLEASE PLEASE PLEASE carry an UPDATED list of your home medications and allergies. I cannot stress this enough–it is immensely helpful in providing you with complete, accurate and safe care. At most hospitals and with most charting systems I have ever used, no it is not “in the computer” or “in your chart” already. There may be a version of some of your medications but a complete and accurate list is something you need to have readily available.

• Don’t lie to me about your drug or alcohol use. I honestly do not care at all what you do in your free time and I am certainly not going to report you to anybody. I simply need to know what I can and cannot give you that could potentially interact with anything that may already be in your system. Be honest with me. Besides, I can already smell the pot on you.

• I love taking care of little kids in the ED; pediatric patients are my niche and I absolutely love caring for them. I feel it should go without saying, but when you bring your child in for emergent care, there is a significant chance that they will need to have some type of blood draw, rectal temperature, nose/throat swab, etc. completed while they are here. It boils my blood when parents act like their nurse is deliberating attempting to inflict pain upon their child. When I’ve heard a parent say “What did the mean nurse do to you?” or get extremely upset that whatever I’ve done to their kid brought them temporary discomfort (especially with IV starts), it upsets me to no end. I feel awful that in order to care for your kid I have to inflict a small amount of pain on them; that happens WITHOUT you egging it on. Please don’t paint nurses to be the bad guys; there’s a method to our madness and all we want is for your kiddo to feel better.

• I beg of you…have advanced directives and discuss them thoroughly with your family so that if the time ever comes where you cannot make decisions for yourself, others know what you want to happen. It is so painful to see a family member attempting to make some of the biggest decisions of their life for their loved one in the heat of a high stress moment. It is physically impossible for them to think straight in those situations. Take the burden off your family and have a plan in place, regardless of how old you are. A DNR (do not resuscitate) is something that you should discuss with your healthcare physician and your loved ones if you are of the age and health status to do so [or if you just want to be a DNR for any other reason]. This is an order from a physician saying that if your heart was to stop beating, no CPR would be done. It is a personal decision and should be an informed one. If you choose to be a DNR, especially if you are elderly, keep a paper copy somewhere very handy. Post it to your fridge; consider even putting a copy on your front door because if the ambulance comes, they are legally REQUIRED to start CPR until a signed DNR is in front of their faces. Make it readily available so your wishes are carried out in a moment when you cannot verbalize them.

• CPR is not like on TV!! CPR IS BRUTAL. Chest compressions result in broken ribs, massive contusions, sometimes even lung injuries. It is not pretty and it is extremely painful. If someone goes into cardiac arrest (their heart stops beating) outside of the hospital, they have less than a 10% chance of survival. And that is simply SURVIVAL. The odds of them returning to the level of functioning they were at prior to their heart stopping is even more slim due to the time their brain was without oxygen. With chest compressions often comes a breathing tube; many resuscitated codes (when the care team is able to get their heart beating independently) never get that tube taken out and breath on their own again. They often live for another day or so and then family has to make the decision to stick them in a nursing home on a ventilator until they die or they remove life support and let them pass away [with broken ribs and likely in pain]. I don’t say this to push you into having a DNR but I have seen people pass away after CPR and I have seen people pass away naturally with their loved ones at their side and the focus placed on their comfort and I 100% know which I would choose.

• If you come into the emergency department in pain, you are often asked to rate your pain on a scale from 0-10; 0 being no pain at all and 10 being the worst pain you can possibly imagine. If you are playing on your phone and calmly tell me that your pain is a 20, I am going to internally roll my eyes and resist the urge to show you what a pain level that high actually feels like. Rarely will anyone ever be truly at a 10/10 on the pain scale; 10/10 means that if I were to set you on fire, you pain could not possibly get any worse than it already is…I don’t see that being the case very often. I have taken care of a man who had a piece of rebar going into his left hip and come out his right shoulder…and he rated his pain a 4/10. You will not get pain medication any quicker if you say 10 but your symptoms and behaviors do not support it. I am much more likely to advocate for you to get pain relief as soon as possible if you give me an accurate and non-dramatic rating. In healthcare, pain is whatever the patient says it is so if you say it’s a 10, that’s what I’ll chart but, believe me, I will also make mention of you sitting in no obvious distress playing on your phone when you said it.

• Being seen by a physician assistant or nurse practitioner in the ED is to your benefit! It is very discouraging when people assume they are receiving substandard care because a physician was not in their room. A mid-level provider such as an NP or PA are overseen by a physician; this means that your care is being discussed and brain-stormed between two professional providers instead of just being addressed by one physician on their own. This makes the odds of finding small “clues” to figure out what is wrong with you even higher. These mid-level providers are competent and skilled or they wouldn’t be able to function in an emergency setting. Plus, nurse practitioners come from a nursing background meaning they will be more attuned to listening to your needs and really hearing you and advocating for you because of their previous training. Please save the jokes about getting a discount because “a real doctor” didn’t see you. It’s offensive and no one appreciates it.

• Coming into the emergency department by ambulance but without a medical EMERGENCY will simply land you in triage where you can walk your booty to the end of the line. In the ED, it doesn’t matter if you arrived by private car, your own two feet, an ambulance or a magical unicorn, we treat patients by ACUITY, not wait time or mode of arrival. When you arrive in the ED and are triaged, you are assigned a level going from 1 to 5. Levels 1 and 2 are the sickest patients and will be seen first, followed by level 3 and so on. If you are a level 5 in a busy ER, you will likely see many people who got here before you be taken back to a room sooner. Consider yourself lucky to not be someone requiring immediate medical attention today. Your wait is an inconvenience, nothing more.

• So why would your healthcare team care so much about you using an ambulance for a non-emergent issue if you’re just going to go to the waiting room anyway? I want you to imagine small town USA. Most small towns have 1 ambulance and the closest hospital to them is a 20-30 minute drive. Say someone calls 911 for a non-emergent issue in one of those small towns and wants to be transported to the hospital; that ambulance now has to drive to that person, take them the 20-30 minutes to the hospital, give report to the ED staff and get the patient moved onto an ED bed [or to the waiting room], write up their report and then drive 20-30 minutes back to their base. Meanwhile in that same town, my grandma chokes on her dinner. 911 is called but now that 1 ambulance that she was relying on coming to save her life is unavailable and she has to wait for an ambulance from a neighboring town to get there. Calling 911 and using an ambulance for non-critical issues is DANGEROUS and irresponsible. Your choice to do so could literally kill someone because help couldn’t get to them in time. Think about this before you dial.

• USE HOSPICE SERVICES!!! Hospice has an amazing plethora of resources that focus on providing comfort care to your loved one. Calling in hospice, however, does not equal a death sentence and it does not say you are giving up. Did you know people can be on hospice, have their condition improve and be taken off again? If things change once more down the road, they can then go back into hospice care. This can repeat endlessly. Just because you’re using hospice does not necessarily mean it is the end; it means that you are focusing on comfort rather than treatment and it is best to get them involved as early as possible. One day I may be able to write about the last days of my moms life, but for now I will just tell you that it is 99% because of hospice that my mom was able to slip out of this world comfortable, at peace and with dignity surrounded by people she loved. I am forever indebted to hospice for this invaluable gift.

• Vaccinate your children. That’s it. End of discussion.

• Just because we didn’t cry in front of you doesn’t mean we didn’t grieve you or your loved one in the privacy of our break room, car, etc. Often when I am the primary nurse for a code that doesn’t end well [as most of them don’t], I spend my drive home “talking” to that person; I tell them that I hoped I did everything I could have to help them and that I hope they are at peace. It may sound strange, but it brings me comfort. I have many patients that I’ve taken care of over the years that I still think of frequently. Please know that if I helped give you a new cancer diagnosis, I will think of you often over the next few days. Things like that don’t roll off our backs like it’s nothing because it isn’t nothing. We are human too.

• On the flip side, sometimes it scares us how little we do feel in some situations. Being an ER nurse makes feeling any type of emotion very difficult because we are often forced to turn it off; we don’t cry as often as most people and we generally have better coping skills than most. We want to feel but our survival instincts have taken over and protected us. It has to be that way or we’d burn out and never survive a full career in this setting.

• We love it when you try to do something about your arm/leg/back/etc. pain prior to coming into the ED. Have you tried Tylenol or Ibuprofen? Have you used ice or heat therapy? Have you tried gentle stretching or a warm bath? No?…great, I’ll go get you some Tylenol and an ice pack. We don’t have a magic wand to wave and make you feel all better and jumping right into narcotic pain medication is what got our country into an opioid crisis in the first place. Put a little effort into your own health and wellness; trust me, if you’ve done all you could at home, I will do all I can to get you feeling better in the ED.

• Along the same lines, please don’t bring your child into the ED with a 104 degree fever and NO medication in their body so you can show me that they legit have a fever. I do not need to see your child having a febrile seizure in front of me to believe that they had a fever at home. Medicate your kiddos! We will believe you.

• Every single one of us in healthcare has their own biases when it comes to the patients they care for. For me, I do not particularly enjoy taking care of bariatric patients especially when I have to move them from point A to point B or use all my strength to push their stomach up so they can use a urinal. I think this stems from being irritated that I have to risk my body and overall safety to move someone who clearly did not or does not take an active role in their own health. Realizing this about myself and understanding that no one is a bias-free angel, I can make sure that I am actively compassionate when put into those situations. I firmly believe that we choose how we react to any situation so I choose to make myself be compassionate even when I don’t want to be.

• Alternately, most nurses also have specific patients that they have a very hard time taking care of for emotional reasons. For example, some nurses who are also mothers have a very hard time taking care of abused children. A nurse who has previously been sexually assaulted may struggle to care for a woman being seen after a rape occurred. For me, I have a very hard time not being upset by patients who are having a miscarriage. I think this is because I hate feeling disappointed more than anything else and I cannot imagine a greater disappointment than finding out the life you pictured in great detail was simply no longer going to happen. Prior to my mom passing, female cancer patients, especially younger ones, were almost too much to handle. Their struggles struck too close to home and it was difficult not to see my mom in them.

• Overall, we are all in nursing because we genuinely love taking care of people and want to make the world a better place. We get great satisfaction knowing we helped someone or even played a part in saving someones life. This is an extremely rewarding job that we are so proud to do. I feel so lucky and blessed to have found a career I can enjoy so thoroughly.

• Nursing is consistently voted as the most trusted profession in the United States. Explain to me then why up to 80% of healthcare workers have been physically assaulted at one point during their career. Check out this article for some jarring information addressing violence towards hospital staff. In my 7 year career I have been punched square in the face, body slammed into a door, had my butt grabbed, been punched and slapped in various parts of my body, been scratched, had my throat lunged at [unfortunately for him my former marine coworker stopped that one] and been verbally abused and threatened more times than I can count [often by drug seeking patients or because of long wait times]. It is worth noting that most of the physical assaults were carried out by full grown men. It is because of these situations that when a family member begins raising their voice at me they have one warning and then I have them escorted out if necessary. I have a zero tolerance policy towards verbal aggression towards healthcare staff; I simply do not tolerate it. Yelling and threatening your nurse is never okay and anyone who participates in behavior like this needs to seriously re-evaluate themselves.

• This may be the most important tid bit that your nurse wishes you knew!! YOU and you alone have the power to decide what to do with your own body, as long as it doesn’t effect anyone else. If you are not comfortable with the care plan or medications your doctor is prescribing, you have every right to refuse them. If you don’t want certain tests done on yourself, your children or other loved ones, you DO NOT have to have them done. Understand that this refusal of care could lead you to being asked to sign an Against Medical Advice form or being dropped as a patient by a certain provider, but if you feel strongly about something, that is your choice. Don’t let anyone tell you any differently. In the same breath, your physician does not HAVE to order any type of test, any type of medication or any type of treatment plan that they do not feel is appropriate just because you want them to. That is their decision and you cannot force them to do anything they do not feel it acceptable to do; they are the ones with the medical degree and that is their right as the expert. Additionally, if you do not understanding something ASK QUESTIONS!! You should fully comprehend any decisions you are making and understand why you are taking any medications that you are prescribed. OWN YOUR OWN HEALTH and keep asking questions until you understand exactly what the plan is and WHY.

Healthy travels <3