Code Blue Nervousness

Editorial Team / Moderator · Nov 24, 2009

My question is this, how do you quell your adrenaline/anxiety when something "big" comes in. I feel I know what I need to do, but get chills and shaky knees, etc when something either rolls through the door such as gun shot, full arrest, etc. For those of you with many years of experience, is this something that just gets better with more experience or is there a method you have found for curbing this adrenaline a little?

I don't have that many years of experience (yet), but I can tell you this -- I still get nervous when I get the assignment that includes our trauma room, because that is where all the codes/MIs/sick-sick-sick etc. patients end up. But I know that when the fecal material hits the fan, it's not JUST ME in there -- there are always hands to help, no matter how short-staffed we might be. It's all about teamwork, and knowing your roles. Practice and experience will help, too.

netglow, ASN, RN · Nov 25, 2009

Not in ER, but in ICU for remaining of school. I am working thru the same. I'm not sure if I got it. But here is something I am working on... I am best when I can control. Being a student I cannot (really? she says) Not that I think I can (I know that I know so little), but this being my second career, I used to have total confidence in what I used to do. This makes me feel "fish outta water" at times in nursing.

If I know the team is there... I try to focus as if I were alone when I can. This kind of lets me think thru things myself, try to let my intuition run loose. I try to block out the fact that my every move is being evaluated, and act like a nurse.

Does that make any sense? I guess it's that I know, YOU got what it takes. You need to let yourself be a nurse.

mommy123RN · Nov 25, 2009

LunahRN-

Thanks for your reply-I'm sure you're right that it gets better with practice and more experience. I'm sure part of my anxiety lies in the fact that we have very few staff on nights. There are 2 RNs, one Doc, and no RT, No anesthesia in house, no PCT, so the buck stops here. Like I said, I know what I need to do, I worry about failing and missing something or messing up, but with that being said our EMS crew is really great and sticks around to help and we have a great team atmosphere so I just need to take a deep breath and do my job, be a nurse and take a deep breath...Thanks for the support :-)

Editorial Team / Moderator · Nov 25, 2009

I know how you feel -- we're in a freestanding ED with 15 beds, so none of the typical hospital resources like RTs, anesthesia, etc., ever -- not even during the day. Staffing at night is even lighter. But our EMS crews stick around when we need them, too. Great people, great team. :)

Larry77, RN · Nov 25, 2009

I find I just go into autopilot before and during the trauma/code...after it is over is when I debrief or take a break if I have to. I find anymore that the only ones that get me are the kids or the young adults...not sure if those will ever get easier.

I remember when I was learning my preceptor would tell me, "Just think about your plan...you know what is going to happen and what you need to do". So before the code/trauma got their I would think about what steps I was going to take and make sure all my equipment was ready. I think that helped with the anxiety beforehand.

OutdoorLovinRN · Nov 27, 2009

I remind myself when we're expecting sick patients of my ABCDEs and that we need to cover those bases and get a set of vital signs along the way. Lab and x-ray and ekg will be outside the door and will come do their thing. I try to review the equipment on slow days (setting up chest drainage devices or running fluids on the level one) Since I don't do these very often. Also, when I am trauma float, I make sure I have everything we could need in the trauma room---seems to be good karma because I seem to have a white cloud knock on wood. I do still get the adrenaline rush. Take your pulse before they come through the door is what some nurses suggest i think.

SpaceCoastRN · Nov 28, 2009

I actually prefer and feel more comfortable with the high acuity cases including codes from my paramedic experience. Hell I prefer patients with tubes coming out of every orifice. The important thing to remember is the first pulse you check is always your own. If you are excited beyond belief you will not be overly effective. The second thing to remember is in a cardiac arrest the patient is dead, it doesn't get much more stable than that. Once they have arrived at being in cardiac arrest the case just got that much easier. Know your ACLS protocols and fall back on them steering the code as needed. Another thing I have noticed is people coding 70+ year old patients for insane amounts of time. When you really come down to think about it, at best, you are going to be making a new nursing home patient with no quality of life. If things are not being fixed within the first 6 minutes or so of a cardiac arrest the results are most likely going to be dismal.

suanna · Nov 28, 2009

Take 3-4 deep, slow cleansing breaths. Relax your shoulders,, streach a little if you can. Think about you child, pet, boyfriend,- anything happy. You need to give your body the clues that this is no big deal so it will quit with the "fight or flight" response. If you can learn to turn your adrenalin off your training will have a much better chance of comming through. If you find your self getting wired try to focus on the priority of the moment- get/give an amp of epi, start an iv, bag, ... Once you get the nerves under control you can look at the big picture again.

Jennifer, RN · Nov 29, 2009

Yes, take some deep breaths. Try to focus on the present, cleanse your mind. It is easy to get overwhelmed and highly anxious before a trauma or coding pt comes in, but it does get easier with time.

Tonjia · Dec 3, 2009

It comes with experience, and knowing what you need to do in a certain situation. give it time and observe some of the more experienced nurses in your unit. It will come...