Calling codes

Having worked on a step down icu/cardiac floor, I always conferred with my charge. If she didn't agree and I still felt strongly, I would indeed call it. It's my license and I would rather feel safer than sorry. If you hadn't called it and the patient were stroking, you would no doubt be the one in more trouble for doing nothing.

The purpose of calling a medical response is to get your patient the help they need now, not in 10 minutes when the physician finally answers the page. For this reason, I don't understand the philosophy of having to consult your charge nurse, or anyone else for that matter, before calling any type of rapid response. And I absolutely disagree with calling the physician prior to calling a medical response. You are the one taking care of the patient. If you, not your charge nurse, but you have any concerns whatsoever regarding your patient's condition, call the response. And after you have done so, never second guess yourself for having done so.

At my facility, as PICU charge nurse, I respond to pediatric rapid response. When I arrive, whether I believe that it should have been called or not, I fully support the nurse in having done so as I would rather respond 99 times when it wasn't needed, than not be called the one time that it was.

Protocol in my facility is to call a rapid if a doc cannot physically be at the bedside in ten minutes. We also call them as needed if there is a change in a patient's condition which may be significant. You did the right thing.

Agreed, you did the right thing. I would rather call a code and get help then wait around and have something happen to my patient. After all, it is your license on the line and more importantly your patient's health on the line.

Its more than just your license. IMO

I am a new nurse as well, but I think its always a good sign to challenge your charge nurse if you have a complete different gut feeling/beliefs... rather than backing down because you are new.

You have had this patient for 3 days straight and recognized a big change in mental status in this patient(Which is why I love working in multiple days straight for stroke patients.. You know the baseline of the patient and is very different.

I'm not a charge nurse currently but when I was I did not hesitate to call a rapid response or code. Trust your gut and trust your assessment.

First of all, the OP is entirely correct to call the "code." Sudden, severe neurological changes should always precipitate further, immediate evaluation and investigation.

On AN, people often say "I talked to the charge nurse and…" or "If you are unsure, ask the charge nurse." It can be helpful to have another person lay eyes on the patient, but at the end of the day, you are the assigned nurse. If there is a bad outcome, saying "but the charge nurse told me to do ____" is not going to be a valid excuse.

"sudden onset speech difficulties, headache and right hand numbness."

I am hoping that you know you did the right thing, and are only asking to feel better about the choice.

I am assuming your "code stroke" triggers a rapid response for a patient who has an acute onset of neuro symptoms. Sudden onset speech difficulties, headache and right hand numbness, for example.

BTW- The whole "it's your license" thing usually comes up in these threads. Nobody lses a license over stuff like this. Continue to do the right thing because it's the right thing to do.

Calling a code is not the same as Rapid response. I would have done an RR.

Escalating it in any way was the RIGHT thing to do, however.

From the description it does not sound like a "code" situation, but rather a urgent response situation. There is a 4 hour window of opportunity for stroke symptoms to be treated with the clot busting drugs. Yes, time is of the essence, but if the patient is not experiencing cardiac or respiratory distress or absence thereof no code situation exists at that moment.

You recognized the change, and responded appropriately. I work rapid response and would rather someone call me, even if I feel it is not needed than not call and should have.

You do not need to need to ask your charge nurse to call a code stroke. You were right to go with your gut.

If it helps, let me reframe it from my POV. During difficult births, the decision to go to c-section is defendable. No one actually gets sued for doing an unnecessary c-section. They get sued for not sectioning when they should (or a myriad other things...but typically not for sectioning and it not being necessary after the fact).

Just calling for eval and RR is not even to the level of doing an unnecessary, but defendable, c-section. No one can say why your charge was reluctant. However, you are the person who gets to go to sleep at night feeling unsure because your charge wasn't 100% on board or feeling regretful for not calling a RR and being swayed against your gut response. If I had to choose, I'd rather go with feeling unsure that my charge didn't support me.

FYI -- that feeling of unsureness is one of the first foundation pieces to the new _you_. When we have to depend on ourselves, even when others aren't supportive of our decision, and then we're positively rewarded with a good outcome -- well, that's a confidence builder and feeds the desire to learn more.

There were times when I knew I was the only one holding the line between good and bad outcomes. I had to get up-close and personal with going to bed full of discomfort and then finding by light of the next day that my decisions still held true the next morning. It really made me develop those critical thinking skills, to be able to defend them with facts and not just be floating along hoping nothing bad ever happened that I wasn't prepared for. Something bad will always happen and you will only ever have the skills you have, the knowledge you have, at that moment and you must use them as best you can. I learned to become accountable for my own education and to drill-drill-drill and constantly be thinking of "What would I do if faced with ?" It makes you a better nurse, a better patient-advocate and a stronger person, IMO, just getting through this day to day business of living that we all have to deal with . :)