A bad code, question skills and career choice.....

[AZER]

Any experienced ER nurses had the occasion to be caught off guard during a code and felt like they underperformed? I did last week, I felt panicky and it seemed like I fumbled around for the first 2-3 minutes. This has never happened to me before, I have participated in dozens of codes. The code outcome was poor and I am having a hard time accepting that my performance was not as good as it should have been. I feel like I failed the patient, the doctor and myself. I have been having a hard time eating and sleeping since then. I just need to know that this sometimes happens, that I am not the only one that forgets to put on the cape and that it can happen even with experience. Does anyone have pearls for me?

[zmansc, ASN, RN]

It sounds like you are taking this rather hard, I'm actually surprised no one has suggested a post incident review and counseling for you and any of the others who were involved in this code. I think something of that nature might do wonders for you.

[R!XTER]

What happened to you happens to everyone. Don't feel alone in this. As much as we try to make the ED (and hospital in general) a "controlled environment" things do not go perfectly 100% of the time. Far from it. We do not exist in a bubble or vacuum. As much as we want everything to go perfectly for each and every patient, the fact is we are all human and no situation is perfect. ANYONE can have an "off" day or moment. The code you're describing happened very suddenly, and there was no way to anticipate it. It would be more shocking if everything DID go perfectly. I have seen the most experienced doctors and nurses get flustered in these situations. Especially when it's a young person, everyone is flustered and grasping.

The fact that you are concerned and bothered says a lot about the type of nurse you are. Clearly you are caring, compassionate, and want to do right by your patients. Take it as a lesson and attempt to do better next time. Every single day is a learning experience

[Sassy5d]

Seems like you are taking the outcome personally. As if you're stumbling or fumbling is the reason for the outcome.

Did you ever get a cause of death? What if it were a PE? Brain anyerism? I've seen many a healthy, active young person drop over..

I'd say you need some debriefing.

[Armygirl7]

Debrief with the team that was involved. After what I consider my worst failed code I asked the attending if we could debrief and discovered that yes I'm important and what I do makes a difference, but I'm not the super uber only person in the code determining the outcome. The resident had had a hard time intubating, the ED Tech had a malfunctioning EtCo2 monitor, etc, etc. I had a hard time getting a second line and there was a delay by a resident in achieving IO access. I did not kill the poor patient, nor did any one of us. We did our best to save him and it just wasn't meant to be.

My first ACLS teacher told us, if you're doing CPR the person is dead, it's a miracle to bring them back, but the odds are not good....and even if we bring them back they may be facing disability and pain....it may just be their time to go.

I felt so much better after debriefing - still sad but not so guilty and over-responsible. We do amazing things in the ER but not all the time, and that's OK because we are always striving to do our best.