Keep Your Bullshit Out Of The ER (11 Reasons NOT To Sign In)

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Keep your bullshit out of the ER.

It’s really quite simple.

As an ER nurse, I have seen A LOT.  I’ve seen death and dismemberment.  I’ve seen heartache and tragedy.  I have seen happiness and joy.  I have seen miracles happen. BUT, I have also seen MORE than my fair share of shit that has absolutely no place in the ER.  Regardless of what you think, member of the public, there are things that you absolutely positively should not come to the ER for.

 Before I get into that, however, I’d like to point out a few warnings about the article you’re fixing to get into.

  1. None of this is about any particular patient or employee or hospital.  These are general statements about things I have heard or general complaints I have seen that are similar enough to be grouped together into one.
  2. There are a lot of curse words in here. Sorry mom, but I am who I am.
  3. If you think this might be about you, it probably is.

And now, on to the list……..

I need a pregnancy test / STD check.

There are only a few instances I can think of where these complaints are a valid reason to be in the ER.

The first is CONFIRMED pregnancy with bleeding.  If you are pregnant, start bleeding AND you have talked to your OB doctor or can’t get in to see them, by all means come have a lie down on this very uncomfortable ER pelvic bed and we will do what we can. If you MAY be pregnant or “aren’t sure” if you’re pregnant, go to your OB.

The second is bleeding and SEVERE pain, with out without a known fetus. If you are literally pouring out blood or have pain so bad that someone has to legitimately carry you to the ER, we have a table and some stirrups for you. But it’s not gonna be pleasant. No puppies and kittens taped to the ceiling to make you forget someone you’ve never met (or possibly several someones) is about to go spelunking in your hoo-haa.

The second is if you have an STD so bad you are legit 1600s Jon Wilmot and have VD-induced organ failure, meningitis, stroke or imminent death. If this ain’t you, go elsewhere. There are 6000 other places that can swab your private bits that DON’T also have dying patients to treat.

Another couple more that go along with pregnancy:

I took X amount of home pregnancy tests but just wanted to be sure.

We use the exact same urine in the exact same manner that you do with a home test.  The test you get in the ER just costs significantly more.

Don’t be that person that comes to the ER for a pregnancy test.

I want an ultrasound because I’m pregnant.

The emergency department is not and has never been a doctor’s office or urgent care facility.  While we have the capacity to run the gamut of testing to diagnose your complaint, we shouldn’t have to.  The OB/GYN office is literally the only place you should go for an US “because you’re pregnant”.

I need a (insert random test that you have literally no symptoms of).

Dear sir or ma’am,

No. Get that out of the ER.

  1. You do not get to dictate the testing (if any) that is performed on you in the ER. While you absolutory have a right to a voice about your care, you do not get to demand a provider order anything. Especially when you have about as many symptoms of said disease as I do.
  2. You did not go to MD school. And even if you did, you’re not the boss in the ER.
  3. There are primary care offices for these kinds of things. You should find one.

In all honesty, there’s a reason why we don’t run random, expensive testing for non-emergenct conditions. The first being the whole NON-EMERGENT part. The second is because we are the ER. We do not follow up with your results unless you are literally dying. So IF you get said testing performed, and IF it’s postive but your not acutely dying, we have no one to send the results to and no way to follow up with you to make sure you get the care you need. Again, PCP offices are GREAT at that sort of thing.

I want a drug screen for my child.

They sell those everywhere. Your pediatrician can do one. Urgent care can probably even do one.

Unless your kid comes in needing Narcan, the ER ain’t the place and we ain’t the ones.

I just want to get checked out for my Cold/Flu/Covid/virus.

“I just want to get checked out” is NEVER a reason to come to the ER.  

We have better things to do than “check out” your cold/flu/STD/bullshit. If you come in for this reason, be prepared to wait. That’s all I’m saying.

Bug Removal

Any and all bugs.  NONE of them are a reason to come to the ER.

Your bedbugs need an exterminator and potentially a blowtorch.

Your lice need one of those fancy combs, some fancy shampoo and potentially manual extraction, but NOT by EMERGENCY DEPARTMENT STAFF.

You can google how to remove a tick.  Even if you miss the head, it STILL isn’t a reason to come to the ER.  

Pain from an injury that occurred greater than a week ago

“I hurt my hand a week ago and it still hurts.”

No.  This is not a good reason for an ER visit.  This is a GREAT reason for a visit to your PCP/urgent care.

Now, I am not saying this is always the case.  If it’s obviously out of place, or you suddenly can’t bear weight on it, or it’s turning purple, then bring yourself in to your local ER and we will take excellent care of you.

If you can smile when using said injured extremity, you’re probably not injured enough for the ER. We are gonna give you a brace, some Ibuprofen (even though you want narcotics because you think that’s the only thing that can help you) and an ice pack and send you back out into the world.

Most types of chronic pain

If you have had back pain for 20 years, we aren’t going to be able to do much for you.  The government has cracked down on the meds that we can prescribe.  Not to mention that if you’re on chronic pain meds for chronic pain, you should be managed by pain management, in which case we can’t do shit for you because pain management will potentially kick you out if they find out you went elsewhere.

You need a work note


This happens a lot, actually.  It’s a damn shame, but it happens.  People miss work for whatever reason and then come to the ER and don’t even try and bullshit us.  They will legit say “I missed work and need a work note”.

I can’t even.

I get it. Employers are assholes and always want documentation of your supposed illness or recovery. The system is fucked up that way. Just like with pregnancy tests, there a thousand other avenues for achieving this, none of which take a bed from a critical patient.

You need a medication refill.

This is another of those “sounds absolutely ridiculous but still absolutely happens” reasons to visit the local ER.  People will come in IN THE MIDDLE OF THE DAMN DAY WHEN THEIR DOCTOR’S OFFICE IS OPEN for a med refill.  

If you have made it this far, congratulations. You made it through what will probably be an ongoing list of reasons NOT to come to the ER.

Should you choose to come anyways…..

You will wait. You will probably wait a while. There is a very good reason for that.

Patients in the ER are not, I REPEAT ARE NOT, seen based on when they sign in. ER patients are seen and treated based on their acuity level (how sick they are). People who need CPR are level one (sickest), people having heart attacks are level one or two, people having abdominal pain are generally level three and so on and so forth.

There are a LOT of things that go in to choosing the patients acuity, and nurses have to be HIGHLY skilled to assign the correct level.

That being said, all of the reasons I listed are level 4 and level 5 acuities. Level 4 and 5 patients generally do not need to be in the waiting room, so they will be waiting the longest to get seen. The only exception to this is ERs that have a fast track system in place, allowing them to quickly see, treat and discharge less acute patients. Fast tracks, however, require staffing that most ERs don’t have.

So just know, if you decide to NOT keep your bullshit out of the ER, your wait will be long and arduous and we will only be minimally sorry.

If you wanna read more about my thoughts on the ER, you should start here.

If you’re already a nurse, I recommend checking out my Amazon store.

Keep Your Bulls**t Out Of The ER

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