Ever going to visit the ER? Read this first!

As an ER nurse, I’ve noticed that a lot of people head to the emergency room expecting immediate treatment and discharge home in time to catch their favorite TV show. Or at least a full night’s sleep before work the next day. One patient even told me she came in because her car was at an oil change and she figured it was a good moment to look into some long-standing health concerns. Please read on to get an idea of what to expect, from beginning to end.

1: Not Sure you need an ER?

You can call your ER or the local nurse help line, or call your regular doctor during their hours. They can help tell you what to do over the phone, but they can’t diagnose you or really tell you answers without seeing you. The ER is open and staffed 24/7, so we are always here, if you are seriously worried, come on in. We don’t mind seeing you and addressing your concerns and making sure you are ok. I would rather talk to 1000 healthy people than hear that 1 person died because they didn’t want to bother us.

2: The ER is not for Long-Standing Concerns

Your belly has been hurting on and off for a month and you are tired of it. Your typical migraine hit on an already-stressful day and it’s overly annoying. You’ve seen your doctor about your back pain over the last 2 years and you want a second opinion. Your fussy baby won’t go to bed easily for the 5th night in a row and you are exhausted. All are valid health concerns that should be addressed, but please call your regular doctor in the morning. Don’t have one? Get one. The emergency will address your concerns, give you sympathy and maybe pain medicine, and make sure you aren’t dying. If that abdominal pain suddenly worsens, or the migraine is different or always requires IV medication, or the fussy baby has a high temperature or isn’t eating, come on in! Otherwise realize that the ER isn’t a quick stop to get fixed.

3: Triage is the First Check

That first nurse you see, who checks your blood pressure and asks about your medical history and why you are coming in today, she’s the triage nurse. Her job is determine how sick you are and assign you a level. She has special training for this job. This step helps everyone know who needs care faster, and helps the other nurses and doctors know a bit of what’s going on so they can get tests started, sometimes before you even get to a room. If you are very sick, having a heart attack or stroke, or are on the edge of dying for any reason, you will get straight back. We don’t play waiting games with serious life-threatening concerns. Sprained wrists, low-grade fevers, young people with a cough, and cuts that aren’t bleeding are stable, in other words you can wait until the really sick people are seen to get back to a room. We know your health concern is totally valid and your time is worth just as much, and you might be rich with the best insurance in the world, but we don’t have unlimited staff and resources, so we have to go in order of greatest need.

4: Be Honest and To the Point

Tell us why you are in the emergency room and what you hope we can do for you. Tell us all your symptoms, even if you think it’s unrelated, and answer our questions directly. Stories about your grandma or the guy you heard about on tv don’t immediately matter to your health. Be honest about your pain, your symptoms, your drug or alcohol use, your previous treatments, everything. We aren’t judging or reporting you, we need to know the truth so we can treat you appropriately. We want to make you better as quickly as possible.

5: Be Patient

It will take hours. On an amazing day, you are looking at minutes in the waiting room and then an hour or more depending on how complex your concern is. On a bad day, you could be facing 2-10 hours in the waiting room. Then an hour or more in a room depending on how complex the concern is. Some ERs in very large cities have even longer waiting times,  up to 12-20 hours. Much depends on the time of day, for example 2am isn’t nearly as busy as 5 pm. Evenings are always busy. Motocross weekends are busy. If there is an event of any sort in town, the ER will be busy.

6: Don’t Compare yourself to Others

A lot of people get upset, especially on busy days, when other people came after them but get back to a room before them. Remember, there are a lot of factors that go in the triage process. The person may be sicker, or may even be moments away from dying. Or this person may have a contagious disease that we don’t want spread around the waiting room (spread to you or your kids!). Or this person may be going to a room to see the doctor before returning to the waiting room. Or they may be going to get an X-ray or blood drawn before returning to the waiting room. Take a breath, we haven’t forgotten you, you are on our list and you will get back as soon as possible.

7: Nurses watch the Waiting Room

We watch you in the waiting room. We see the nauseated 25 year old complaining of 10/10 pain eating cheetos. We see the short of breath man outside smoking. We see the tough little 12 year old that says he isn’t in pain grimacing every time he moves. We can’t see you if you leave our waiting room, though. If you go out to smoke or sit in your car to wait, you won’t hear us call your name. We can’t go outside and check cars every time a person doesn’t answer. If you decide it’s not worth the wait, please let the person at the desk know you are leaving. If you feel you have gotten worse while sitting there, let the person at the desk know so a nurse so re-check you.

8: Fast Track MIGHT be Fast

Some ERs have rooms that are smaller with fewer supplies. These are called “fast track”, where simple health concerns can be addressed quickly. So if you see someone you consider less sick than you going back before you, it may be that there is a fast track room available, where there aren’t enough resources for a more sick person. A small cut can be stitched or the dental pain can be examined and sent home. On busy days, these rooms might not be available, so don’t bet on being able to get seen fast and go home fast for easy things.

9: Getting to a Room may mean more WAITING

Once you get back to a room in the ER, the doctor isn’t going to be standing there waiting for you. Ambulances and sick people are coming in those doors constantly, so the doctor and nurses may be wrapped up in a lot of other things. Be patient. We know you and your time are important, but if 4 people don’t meet you in room, you probably aren’t dying and can wait a few more minutes. If we look through the door at you while we walk by, it’s not because we are ignoring you. We see you, we know you are still awake, healthy-looking, etc. A nurse can learn a LOT by looking at you for a few seconds. We will come see you when we can. We are always treating patients based on who is sickest and needs attention fastest.

10: Ask if you Need Something

When you need something, definitely ask, then give the nurse some time to get it. You are in pain, or nauseated, or thirsty, or cold. It’s a valid concern and I will address it. For most things, especially medications, I have to get a doctor’s order, which means talking to the doctor who also has many other patients with sometimes very serious needs. Your need for a bit more pain medicine won’t beat out the intubated patient’s need for sedation or the guy having a heart attack who needs an IV so he can get life-saving medications. Of course, 5 extra minutes may feel like an eternity to you, and if you have a problem that needs to be addressed immediately, we will address it immediately. Otherwise, if you haven’t gotten your need fulfilled in 20 minutes or so, now is the time to remind someone.

11: Laughter is OK

Everyone says laughter is the best medicine. We will try to lighten the mood in your room, and you will probably hear us laughing in the halls and at the nurses’ desk. We are surrounded by sickness and sometimes death, so laughter helps get us through the day. We cry, we mourn, we care, but on the surface, we laugh because we have to keep going. Because there are more people waiting, so we have to keep moving.

12: Trust Us!

It’s an emergency room, so we are going to make sure that you aren’t dying. We might do an ECG to make sure you aren’t actively having a heart attack. We might draw blood and put in an IV so we can start tests and give medications. We might put you on a monitor so we can watch your heart rate, oxygen and blood pressure – these numbers mean way more to us than you may ever know! The doctors might order x-rays, or CTs, or other tests to figure out what’s going on. They might order medications, decide if you are healthy enough to go home or need to stay, and write prescriptions as necessary. Trust them! DO ask questions, understand what is going on, it’s your body and you know how you feel. But trust us, let us put you in a gown and do our tests, it’s the way of figuring out what’s wrong.

13: You might not get Answers

Sometimes you aren’t dying, you don’t have an infection, you don’t need surgery, or there isn’t a cut to stitch or a bone to fix. Sometimes, there isn’t a clear answer. The ER doctor will do everything he can to make sure you are not dying, then he’ll pass you on to someone to help get you answers. If you are very sick and need continued medical attention, this may be through admission to the hospital. If you are healthy enough to go home, this may be through seeing other doctors over a period of time.

14: Admission to the Hospital Happens

If the doctor wants you to stay, please stay. I’ve heard too many patients say they can’t stay because their dogs need them. Or they don’t have their pjs. We have phones you can use to call a friend or a neighbor. Then be patient while we find a room for you “upstairs.” We can do everything in the ER that they can do upstairs, the reason you haven’t moved is not because we are lazy or have forgotten you, it’s because they don’t have a bed or a nurse to cover you upstairs. So we could move you, but you wouldn’t have anywhere to be or anyone to take care of you. Be patient, we’ll get you upstairs when we can, in the meantime we will do our best to continue giving you the best care in the ER.

15: Follow Discharge Instructions

When the doctor has decided that you are healthy enough to go home, he might have answers or he might not. He might have prescriptions and recommendations or instructions for you to get better. Follow them! If he tells you not to go swimming in the river with your freshly sewn cut, don’t go swimming. Or to eat bland foods and take your antibiotics until they are gone, do it. The spicy food can wait. The hot tub can wait. If he gave you antibiotics, take them until they are all gone, even after you feel better. Your health is more important.

16: Follow Up As Instructed

No matter what, the doctor will want you to follow up with your regular doctor. Don’t have one? Get one. Call your insurance, figure out who is covered, and make an appointment. The ER doctor might have you follow up with a specialist, do that. Like I said in the beginning, the ER is not for long-standing health concerns. It’s not for renewing prescriptions or checking out the pain you were here for a month ago that hasn’t gone away and you haven’t followed up with a regular doctor. Really truly, I hear at least twice a day that the person was already seen in the ER for the same thing and hasn’t followed up with a regular doctor because “I didn’t have time” or “I don’t have money”. Trust me, the ER takes way more time and money than a primary doctor.