Question for the experienced cards rns

  1. Hello, I am a "2nd career" rn since dec 04, and have worked on an interventional cards floor since feb 05. My problem is that I still haven't had a lot of exposure to the dire things- codes, etc, to know to be confident. I haven't had to actually defib someone yet, or put them on the zoll, or even do cpr for that matter on someone.How do I gain any confidence? I asked my manager if i could maybe shadow in an ICU, but she says no, you will see enough here. But I haven't seen enough, and it's been over a year and a half. Today my pt started floating between 3rd deg. avb, and vtach as high as 200's. managed to get the right personel involved and they sent him to the unit- but I will guarentee my hr was prob 150(no lie, i was shaking), but i knew the potential to defib him was quite the possibility.I'm finding I don't like that kind of adrenaline rush ! and I'm not sure if it's because i'm not confident, or if I need a different setting to work in.Do any of you more experienced RNs have any suggestions? Is there some other setting thats not so "exciting"? I don't know how long my heart can take that rush. I'd say it was bordering on panic, but i kept telling myself to keep my cool and do what is necessary. Whew. Thanks in advance for any advise. JR.
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    About martymoose

    Joined: Jan '03; Posts: 1,893; Likes: 4,308

    11 Comments

  3. by   augigi
    Sounds like you just have anxiety based on lack of experience, I don't think you should look for a new ward just yet. You did the right thing in asking your manager for more experience, and it was a shame she blew you off. Does your hospital have a "code team" you could follow? Make a written request to your manager if necessary to leave a paper trail, so that if you DO decide to leave, there is evidence that your learning needs were not met.

    Doing anything over and over makes it easy to handle. In a lesser way, so does learning about it. Why not do a CE course about arrhythmias, or code management? There are heaps of books and articles about this that could help your confidence as you learn. There are websites you could do a google search for, and read some online stuff.

    Wherever you go, apart from palliative care, you will need to deal with rhythm and code management. It's just another skill that comes with time.

    Good luck!
  4. by   vamedic4
    I agree with augigi...let your manager know how you feel, and leave a paper trail.
    Everything comes with time, but the more prepared you can make yourself, the better prepared you'll be when necessary. Take an ACLS course or whatever other course you think interests you. The ENA has bunches of courses you can take to expand your clinical knowledge.

    Do yourself a favor...go in to work...perhaps on your day off or anytime during your shift when you have some downtime and familiarize yourself with EVERY PIECE OF EQUIPMENT on the crash cart. Ask questions of others as to the function...how do I do this, et cetera. It's best to find an "educator" or "preceptor" type person, as they should have a better knowledge and experience base, but this isn't always the case.
    This way, you will at least be somewhat familiar with your equipment.

    KNOW HOW TO BAG A PATIENT EFFECTIVELY. Your most important skill as a nurse is to maintain an airway. Practice with the equipment. Get to know it. Bag the bed if you have to, just to get the feel of it.

    The more you do, the easier it gets.

    Good luck to you!!!!

    vamedic4
    getting the monsters out of bed
  5. by   martymoose
    Thanks vamedic and augigi- those are some good ideas. I think im one of those "hands on" learners, so that must be where the anxiety comes in. Maybe I should go to one of the icu managers and ask them if i could shadow.I'm not sure how it would work to follow the code team- theyre mostly the residents that get paged overhead. I did have a thought though; I drove by my local ambulance today and they have a sign out there looking for volunteers. Does that sound like a good idea? Thanks for the help- JR
  6. by   vamedic4
    jrwest...as a medic, I think it's an EXCELLENT idea to do that. Take an EMT course - you'll learn new skills that you will find useful. Volunteering is an excellent way to give back, and learn new skills!
    Plus, it'll give you a lot more perspective about what goes on BEFORE the patient gets to the ER.
  7. by   Dinith88
    Quote from jrwest
    Hello, I am a "2nd career" rn since dec 04, and have worked on an interventional cards floor since feb 05. My problem is that I still haven't had a lot of exposure to the dire things- codes, etc, to know to be confident. I haven't had to actually defib someone yet, or put them on the zoll, or even do cpr for that matter on someone.How do I gain any confidence? I asked my manager if i could maybe shadow in an ICU, but she says no, you will see enough here. But I haven't seen enough, and it's been over a year and a half. Today my pt started floating between 3rd deg. avb, and vtach as high as 200's. managed to get the right personel involved and they sent him to the unit- but I will guarentee my hr was prob 150(no lie, i was shaking), but i knew the potential to defib him was quite the possibility.I'm finding I don't like that kind of adrenaline rush ! and I'm not sure if it's because i'm not confident, or if I need a different setting to work in.Do any of you more experienced RNs have any suggestions? Is there some other setting thats not so "exciting"? I don't know how long my heart can take that rush. I'd say it was bordering on panic, but i kept telling myself to keep my cool and do what is necessary. Whew. Thanks in advance for any advise. JR.
    You're jittery from inexperience. Thats normal and will get better...but will never go away. Thats good. Think of that as your 'edge'. It keeps you on your toes, your head clear (eventually), and your reaction-time quicker. It may make you age faster..but thats a price we pay for working these areas

    I disagree about taking an EMT course, unless you eventually want to be a paramedic (at least 2 years?). YOu'd learn how to extract broken people and package them for a truck-ride to an er...and do cpr. All thats stuff is cool and has it's place but would be of no benefit for helping you in your current position...i think. YOu need to see/do acls/codes in the hospital to gain experience.

    If you're worried about codes, i'm sure you could arrange with your boss..or the code-team...(or whoever) to respond to as many codes as you are able...as an observer, to help familiarize you with all the stuff they do.

    And the one thing you'll eventually learn (and most/all nurses with lots of experience in code-siuations will attest to this)..that coding people is actually 'easy'. Scarey at times ( if it's YOUR patient), an adrenalin rush for sure...but not 'hard'...especially in the hospital where there're a gazillion people wanting to stick their noses in and get involved. ACLS, codes and such are scarey, intimidating, confusing and overwhelming to people who dont do them...and is the biggest reason why people dont get into more critical-care type areas...but it's only a psychological hump.

    Er nurses, critical care nurses, paramedics and people like that do codes all the time...and it becomes second hand, old-hat, and 'easy' for them...but it's not because they're better nurses, more intelligent, or more aggresive. It's simply because they do it, and do it alot. Just like any other job.

    It's keeping the patients from coding that's the hard part.
  8. by   floridaRNtoo
    Dittos to the above replies. Continue to educate yourself with ACLS training and look for opportunities for cross-training. Maybe you could do some per diem work on a different unit. It's too bad your manager doesn't support your efforts. It does get easier with experience. We have a 'rapid response team', a team of ICU,CVICU nurses that respond to a floor nurses request for help. They can help analyze the situation, organize info. get calls out to doctor's and hopefully prevent a code. With a 5:1 ratio on our telemetry floor, we welcome the extra help when we have a patient crashing. Maybe your nurse practice councel or some committee in your facility would welcome this suggestion. Hang in there. I love this kind of nursing.
  9. by   floridaRNtoo
    OOps, My spelling in the above message needs some help. English majors please forgive me!
  10. by   martymoose
    HI all thanks for your replies. I was just wondering if being part of the volunteer ambulance would gain some experience.As far as working in other areas, i would love to( but stay at my"homebase") but i would need orientation, right? for the new areas. i dont know if they would be willing to do that.I wouldn't know how to go about" advertising myself" do i go to the nursing office? or to i find out who some other managers are and ask them? I havent worked anywhere else for 1.5 yrs fulltime. maybe someday I'll figure it out.(if i dont go into psvt first!)Thanks. chris
  11. by   SEOBowhntr
    I suppose this may be the wrong way to look at it but....... I always decide that the pt. will likely live or die regardless of my actions, but I should at least give them my best efforts. Sometimes you just have to experience a few EMERGENT situations to develop a sort of "comfort" zone in them. Some people never get "comfortable" with patients needing emergent interventions, and that is fine also, that is why there is such diversity in nursing. I thrive in stressful situations, and rather enjoy the opportunity to "cheat death." A shadow in ICU may or may not benefit you, but if the opportunity is provided, you may benefit from taking the opportunity to respond to a few codes and just observe, to get a feel for the things that go on during a code, and see the interactions between the members of the code team. That has helped some of my nurses.
  12. by   calicamper
    I had my first code two weeks ago after working for 13.5 months. It was such a relief for me b/c like you describe, my anxiety was so high. My colleagues got me very involved, though. I took turns giving drugs, doing compressions, handing drugs to others. I even made an epi drip. I also helped doppler the femoral pulse. I know the next time there is a code, I have experience...and I won't be as scared for a code as I'd been over the past year. I recommend you follow the code team at your hospital. There should be a code nurse from an ICU on call for codes that day.
  13. by   AfloydRN
    My best advice is to spend a day in the ER. You WILL get probably alot more exposure than you want. We code people every day. You can learn alot there and start to feel more comfortable in your job.

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