Feeling BLUE after a CODE!!!

[lisa41rn]

Help! My biggest fear which was inevitably going to come true, finally did today....twice!! Two codes were called on patients. I think PACU was sending patients to my med/surg floor a bit too soon. Well, for the first code, I was the second person to arrive. I was asked to call a code, ran to the desk and felt like I was yelling to call a code. Well I was shocked that my "team" was quick to highlight all my reactions after the code was over. I have to say, I felt so nervous, but thought I did okay. They told me my happy face was the most serious they ever saw, but was really demeaning. Because we don't have a lot of codes, no one seems like an expert, but we did okay, so why make anyone feel like a fool?!!.. which was exactly the way I felt. Was I suppose to be smiling while calling a code? That code was quickly cancelled and the patient was okay.

This same day, another older patient coded. This time I ran down helping by getting things etc. I felt better about it. Later I heard the secretary criticize the way a nurse told her to call the code. It really is annoying that we don't help each other out. I try to find something positive to say in situations like this, especially with the obvious nervous ones. Hey, does it really hurt to say something nice?! Even to someone standing in a code appearing in shock themselves, I'd probably say "thanks for your help"..that is, if the day ever comes where I'll be more able to handle a code myself. I often try to help out the new grads in this way. Gosh, they need encouragement whenever possible.

Anyway, is this normal to criticize each other during codes? I felt so sad and discouraged with myself for being so obviously nervous, I questioned what I'm doing for work. We were quick, there were a ton of people, nothing was delayed. It seems inevitable that one person seems to get picked on during a code on my floor. Is this normal?

[Tweety, BSN, RN]

Usually after a code I've noticed there's a process of debriefing. It's such an upheaval to a unit it's natural to talk about it for a while afterwards, what happened, what went right and what didn't.

I don't find it inevitable that one person gets picked on in my experience. But people can be judgemental so it doesn't surprise me.

[anne74]

That's terrible to criticize someone after a code. In fact, it could hinder your behavior in the next code and make you more timid. They're the ones who should be feeling badly - not you. You were doing your job.

[gradcare, LPN]

First question, were they both "saves?" if so well done, codes are a very stressful time for all who are involved regardless of how many you have been through. I have seen codes in ward environments, ed's OT's and of course critical care units. Everyone reacts if different ways, sometimes it is easier to critsise others then to evaluate you own performance. I don't know whether at you intitution or not it is offered but many bigh places have a staff psychologist who can facilitate a formalised debrief where you talk about what happened why it happened and "could we have done better?" Ask around see if you can get a debrief going. It may be that you co-worker reactions were due to the after effects of the adrenaline "rush" or just generalised stress.

It also maybe that the secretary had a point perhaps the person told her to call the code without all the relevant information ie bed number or was talking too fast so they couldn'e understand. That said however there is no reason to publicly state this when a quiet word in that person's ear would have done.

In answer to you question if it is normal to "pick" on someone no way. Constructive critisism of the process yes personal attacks no, personal performance (if positive should be mentioned if negative should be mentioned but very gently and constructivly).

Final point though probably a little over laboured, reflect on what happened and your role, how you did and either give yourself a large pat on the back or work out a way to improve (or even both for different things)..Anyway that's my 2cents worth

[gradcare, LPN]

In reference to my earlier post I also should have said that even after all those codes I still occassionally feel ill to the pit of my stomache I can just bottle it until after the code is over (then I get the "adrenaline shakes" a little).

[icare4icu]

Give yourself a pat on the back. You shouldn't feel embarassed by your own reactions. I've seen nurses actions worst than that. For example, one charge nurse tried to pull the crash cart without unplugging it. She pulled so hard that she fell backwards. I, in one occasion pinned one RT against the wall with the patient's bed and bruised the other RT on the leg because I pushed her aside to do CPR. Well, she was stunned and did not move.

It would be a good idea to suggest to your director to have a mock code often, or have the specific functions of each nurses during a code. Hey, if the hospital has a code team, once they get there, it's their job, usually.

Anyway, take it with a grain of salt, the more you get exposed to it, the better you'll be at it. Good luck.

[lisa41rn]

Yes, both of these were saves. One was transferred to ICU, but was stable and talking before the transfer. She was only on our floor for about an hour. I try to look at this as some criticizing others for their own insecure issues, but that doesn't help. While I always felt I needed to experience one code to at least see the "real thing" and I'd feel more control, I never expected two codes in one day. It makes me wonder why two happened so close together!! At least I felt better about the second one as I was able to help out more. We have a rapid response team which helps prevent codes thus the reason for so few codes. Plus our director says it's due to great nurses...that's nice to hear.

I just feel so paranoid about codes. I know I'm not alone. I think constructive criticism is good, but to focus on one person is terrible. Why people, especially nurses, can't give a pat on the back once in a while is a shame. I try to rethink this and know it was told to the secretary clearly by myself to her. Others reacted immediately. Then I think less of those on my team who would comment about my nervous/serious expression during this code. Anyway, thanks for your support!!!

[CHATSDALE]

some floors depending on the type of pt they have do have frequent codes but they can happen anywhere at any time

as to your coworkers they are probably trying to get their own feelings but transfering them to you there are people like this

[gradcare, LPN]

"I just feel so paranoid about codes. I know I'm not alone. I think constructive criticism is good, but to focus on one person is terrible. Why people, especially nurses, can't give a pat on the back once in a while is a shame. I try to rethink this and know it was told to the secretary clearly by myself to her. Others reacted immediately. Then I think less of those on my team who would comment about my nervous/serious expression during this code. Anyway, thanks for your support!!!"

Then her reaction was probably due to HER internal processes.

As to commenting on you facial expression someone who wasn't watching where the action was.

Besides a common quote from ED and ICU is "its sad that for me to have a good challenging day someone else's day has to have gone to hell". People have funny ways of protecting what is in their headspace. I think with these occassions you just happened to cop some people who externalise what's happening within them (oops think i've been watching too much Dr Phil).

Don't be paranoid obout codes fear is the mind killer that freezes your thoughts and actions. Try playing what if and having a game plan for what happens if you patient codes for all you patients and try to arrange drills with you nurse ed.

Good luck

[EricJRN, MSN, RN]

One thing to keep in mind is this: Whether they admit it or not, everyone's adrenaline is probably still pumping after a code (even the non-clinical personnel including your unit's secretary). A lot of times, this causes one's mouth to move much more quickly than one's brain. It doesn't excuse the fact that she made fun of you, but it might help explain it a little.