Code Blue...

One of my patients coded during my last week of orientation, then another nearly coded my second or third week off of orientation. Today one of my co-workers patients coded. As is the usual case both of the patients who coded died. Both of them were quite advanced in age, and both of them showed signs of impending death (decreased intake, worsening function of multiple organ systems, etc.). In all three cases, including the one where the patient did not code and did live, I have gotten the worst sort of adrenaline rush possible. Today my skin started tingling after the code, and I have gotten at least a bit nauseous after each code and the near-code. I am on a med/surg tele floor, and it seems like there are an awful lot of codes on my floor. I know I have put a whole lot more time in over the few months that I have been out in the nursing work force compared to my time in school, but I do not remember any codes throughout my education. I was on one step-down unit at a university medical center with complicated patients, so I am surprised that I did not see any codes there.

What I really want to know is how many codes any other first-years on med/surg telemetry floors have experienced, including with patients that are not yours. Today's code was a little bit easier for me, in part because it was not my patient and also because I had already been in a code. My other question is, have you gotten used to it? I have not been so upset about the death of the patients in either of the codes as I had been with the process of the code itself. I know now that the my patient would not have been coded had I acted more appropriately on the information available to me. I do not necessarily believe that the patient would have lived had I acted differently, but had I done a better job of communicating with the family about their wishes when the patient began to go downhill we could have at least gotten a DNR order in place. I spent a whole lot of time thinking about what went well and what did not, and I have learned from the process. I think I've managed to get on the nerves of our cardiologists by being a bit hypervigilant, but better to be hypervigilant in the learning phase than to be undervigilant. Anyway, any shared experiences would be appreciated.

And one last thing. We have students on our floor now, and having gone through the first-time experiences of being in a code after starting work, I really want to invite students into codes so that the whole experience is less traumatizing once they have to deal with it on their own. Does this sound like a good idea? Should it happen, I would assign a role to the student (probably recorder, compressor, or ventilator), and direct the student as needed during the code. I know it is an intense situation and you have to act fast, but with adequate direction I think students can perform specific tasks in code situations without affecting the outcomes of the code (of course mileage will vary per individual).