ACLS Experienced Provider Course

hodgieRN · Oct 9, 2011

I don't think it's bad at all. I've taken it a couple of times over the years and you spend 80 % of the time learning. You get lots of information and you'll be a better nurse for it, especially during a code. The mega code is not bad. They are not there to mess with you or trick you. Maybe a curve ball here and there, but they are there to help you learn. I think if people have a difficult time with the mega code, it's more about you not paying attention during lecture or just getting stressed when only it's you and everyone is looking at you. Probably more stage fright then anything.

Funny I came across this post b/c I just did my re-cert today. A lot of the guidelines have changed since last time. I when to Heart.org and did the pretest and watched the videos before class and it really helped. Now, airway is not the primary thing now. It's compression. Used to be ABC...airway, breathing, circulation. Now its check responsiveness, check pulse, do compressions, then airway--getting someone to bag or give 2 breaths after you've done cpr for 2 minutes if alone. Giving 2 breaths before compression is no longer indicated....there's no point giving a breath when no blood is circulating. More interruptions of compression = higher mortality. Next- you are required to give compressions while defib is charging up...do not stop. There is no more atropine for PEA (pulseless electrical activity) just Epi and Vasopressin. Atropine is only for bradcardia. Next, you do 2 minutes of compressions AFTER you get a pulse back...you don't stop. When a pulse comes back, the ejection fraction is close to nothing, so you still have to circulate. There are new guidelines on capnography - it is the best indicator of good compression. C02 levels less than 8 = bad compression. It needs to be higher. Calcium and Bicarb are now considered Class III.. they are no longer used. Bicarb is only given if the code has been going on a long time, never give in the beginning of the code.

There is a lot of new stuff this year. And I think it's easier...things are very straight to the point. And if want, sign up for an advanced telemetry class you can identify a rhythm right away (it includes all of the rhythm strips for myocardial infarction.)

During the mega code, some things might be going on and then the instructor will say " And what next?" It's vague and you have understand what they are asking but if you just retrace your steps and talk out loud to yourself, you'll catch it or they will see you have the ability work through it and the instructor will give you a hint and then you run with that. They aren't there to fail you. After it's done, You'll say "that wasn't so bad." Things seem bad when you pause...and say "um", then silence, then give up. Pretend you are the doctor and what you say goes. Have confidence. Delegate. You--ventilate this guy giving one breath every 5-6 secs, continue CPR, "How long since we gave the last epi?" "5 min" Ok, give another amp of epi. "How long has this cycle of compression been going? " "2 min" Ok, pause CPR ,You...do you feel a pulse. "no" Ok continue compressions for 2 minutes. Remember to switch out people doing CPR. Make sure someone is documenting and one for the drugs. Know the rhythms. "He's now in Vfib" OK, you, charge defib kits to 200 joules . Stuff like that. Don't be afraid to take charge. It's your code! Give polite commands and delegate. That's what running a code is all about.

Upgrading_Status, BSN, MSN, RN, NP · Oct 12, 2011

Given all that you have said, would you advise a fairly new nurse to take this class?

Grumpy's Girl · Oct 12, 2011

Our nurses enjoy (if you can "enjoy" testing) the Experienced Provider Course better than the ACLS or ACLS recert. Though our recerts are run more like the EP class now. It's geared more for those who have had ACLS at least once and have had experience with codes and critical care. It seems to take ACLS a step further. More understanding whys and application. We enjoy it because there is a lot of group discussion and shared real life experiences. Gives reality to the algorhythms. The doctor leader that has worked with us and the nurses instructing have bent over backwards to make it interesting and a relaxed learning experience so it sinks in. HodgieRN gave good suggestions. You should teach it.

billyboblewis · Oct 13, 2011

The course is necessary for employment in many institutuions. The people who give it and their relationship with the hospital has a great deal to do with how hard the course or even the length of it. Some very strict hospitals go by the book. Other hospitals just want all their employees to have certification because it makes them look good and there courses are watered down. I have been taking these courses for years and havent flunked yet.

hodgieRN · Oct 15, 2011

Given all that you have said, would you advise a fairly new nurse to take this class?

In my opinion, there is nothing wrong with taking the class if you are fairly new (maybe at least 6-12 months in). Here's why...becoming an ACLS provider doesn't mean you are going to be in charge of codes if it happens. There will be a number of others who are also certified and there will always be help. When a code occurs, you will be able to watch and apply things in your head b/c you know what is going on. Over time, you will be able to be the resource. A code is a team effort, but it's amazing how many codes have people just standing around, fiddling with stuff, and trouble shooting the bedside doppler. The class is a great learning experience. You can find classes that are one day, but some can be two days with more info.

However, there are things you need to already know before going to the class. I took a basic telemetry class and then advanced telemetry before I took ACLS, but you don't need to if you understand how to read rhythms. I just did that b/c I wanted to learn about the ins & outs of MI's, which they briefly talk about in ACLS. You will need to know the P-R interval or ST elevation. Can you identify a second heart block type II vs type I? Can you identify polymorphic v-tach or a-fib vs a-flutter? A lot of it is knowing the rhythms. If you know the rhythms and know what epi, atropine, and amiodarone is, then you are set. A basic telemetry class should cover that. They also go over advanced airways (which you don't need to memorize) but having a basic understanding of an ET tube or an LMA will help. They also go over stroke, which includes fibrinolytic therapy. Once you feel comfortable reading rhythms, understand medications, and have some experience under your belt, absolutely do it!

Upgrading_Status, BSN, MSN, RN, NP · Oct 16, 2011

Thank you HodgieRN. I will follow the steps you provided. I'm a year into my place of employment but the only strip I can read are normal sinus rhythms and flatlines Thanks for the advice.

hodgieRN · Oct 17, 2011

No problem! Let me know if you have any questions ACLS content. It's one of my favorite subjects. See if you can chat with a CCU/CSU nurse...they are wonderful resources and very knowledgeable, especially with rhythm strips.

kaedawn · Oct 18, 2011

It is most gratifying when experienced nurses like hodgieRN choose to encourage, teach, and mentor those who have yet to take ACLS, rather than berate and criticize. HodgieRN stresses the benefits of careful preparation for ACLS, ultimately yielding a better outcome for everyone in a 'real' code situation! Thanks, hodgie, for an excellent post!

detroitdano · Oct 18, 2011

I'm definitely going to take this. One of my good friends at work actually teaches the course so that should make it less stressful.

Relearning rhythms and treatment modalities for an entire day would be such a bore. One of my friends who works a transplant floor is learning rhythms, he was over here last night and I schooled him a bit. Reading strips is child's play now. I remember looking through the ACLS study guides and thinking it was a bit of a challenge, now that stuff is cake. I'm ready for something more advanced.

hodgieRN · Oct 19, 2011

Good stuff! If you can read strips, then ACLS should be a great experience. The best part is applying the treatments under high stress. It's not about knowing what needs to be done, but what shouldn't be done. Making a split second decision to shock someone could cause asystole if the rhythm didn't call for it. And it teaches you to stick to protocol even when a the practitioner says otherwise. For example, I've heard some doc's still order bicarb in the beginning of the code, which is wrong. Or, routinely stopping compressions for a pulse check...you should say "guidelines says we should continue compressions for two minutes, so we should continue and we will check a pulse in two minutes. If you really want something more challenging and rewarding, become an ACLS instructor. Teaching is one of the most gratifying acts we can do for each other. Passing our knowledge on to others, especially new nurses, is fundamental. If you become an ACLS instructor, you will have the opportunity to grow through the education others. And the time will come when those nurses will face a code situation, and their actions will be based on what you taught them. I think there is a great sense of pride in passing on what we have learned. Whether it's teaching an ACLS class or when you had a buddy over to teach him strips. When I was a student...getting ready to hit the floor for clinicals, I always hated being paired up with the one nurse that said her motto was "Nurse's eat their young." Complete crap! So if you get a chance to be an ACLS instructor...I say do it! There is nothing better than teaching!!!!

albulove · Nov 15, 2011

Aw great post, thanks so much for this! I agree NObody wants to be with or should have to for that matter, with the ****** nurse who hates their job and is rude to students.