4.22.2010

RED's Rules


Okay, I've been having to train new nurses lately. Not just new nurses to the ED. But nurses that are new to everything. I've been giving them my rules. Mine aren't as refined as the House of God rules, but I'll keep working on them. I'll take suggestions too! 

  1. Bringing a crash cart into the room can ward off evil spirits.
  2. Don't panic. If the airway is patent, get a set of vitals. It's useful information and buys you time to figure out your next move. Moreover, it makes you look like you know what  you are doing.
  3. We have to treat all our patients, not just the nice ones.
  4. The patient is not the enemy. 
  5. There are many reason for people to be assholes - demanding, agitated, argumentitive. Sometimes it is an underlying disorder of the personality that you have no control over. Sometimes it is because they are dying. Often they don't know what to expect and aren't used to being powerless. At the very least, it may be because you just met them on the worst day of their life. This is a good possibility given that they are in an emergency room.
  6. You job is to try and be the best part of the worst day of their life.
  7. The Emergency Department is an easy place for a nurse to kill people. If you don't walk into work a little scared of doing so, you probably aren't paying attention.
  8. Err on the side of the patient. Over time, it is always easier if you do the right thing in the first place. That said, it is never too late to do the right thing.
  9. Doctors will yell at you for doing the wrong thing just as they will sometimes yell at you for doing the right thing. Thus, it's easier to do the right thing. 
  10. You are never the most important person in the patient's room.
  11. Don't pre-anger the patients in triage. Don't argue with patients in triage ... just nod your head and get as much information as you can. Let the doctor piss the patient off or do your discharge teaching right before you send them out the door -- not in the triage room.
  12. The one time you don't do what you always do, you will get burned.
  13. If a patient says they have esophageal varricies and their chief complaint is "vomiting" they need two large bore IVs -- even if their vitals are perfect and they look the picture of health. 
  14. Chart like your license depends on it.
  15. EKGs are cheap, undetected MI's are expensive. If you ask yourself: "Should I get a 12 lead?" The answer is always yes. 
  16. Check blood sugar on anyone with altered LOC.
  17. You patient's blood pressure will drop about ten minutes after you start the IV antibiotics and just before you admit them. 
  18. Don't DC an IV until the patient is dressed and in the wheel chair ready for discharge.
  19. Don't argue with drunks or crazy people. 
  20. Some people suffer from undiagnosed UAD (Underlying Asshole Disorder) 
  21. Don't take it personal. They don't know you, and with any luck you won't see them tomorrow. 
  22. Leave 'em better than you found 'em and you've done your job. 
  23. Nurses don't work for doctors, they work for patients.

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