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Discussion

Code Blue...

One of my patients coded during my last week of orientation, then another nearly coded my second or third week off of orientation. Today one of my co-workers patients coded. As is the usual case both of the patients who coded died. Both of them were quite advanced in age, and both of them showed signs of impending death (decreased intake, worsening function of multiple organ systems, etc.). In all three cases, including the one where the patient did not code and did live, I have gotten the worst sort of adrenaline rush possible. Today my skin started tingling after the code, and I have gotten at least a bit nauseous after each code and the near-code. I am on a med/surg tele floor, and it seems like there are an awful lot of codes on my floor. I know I have put a whole lot more time in over the few months that I have been out in the nursing work force compared to my time in school, but I do not remember any codes throughout my education. I was on one step-down unit at a university medical center with complicated patients, so I am surprised that I did not see any codes there.

What I really want to know is how many codes any other first-years on med/surg telemetry floors have experienced, including with patients that are not yours. Today's code was a little bit easier for me, in part because it was not my patient and also because I had already been in a code. My other question is, have you gotten used to it? I have not been so upset about the death of the patients in either of the codes as I had been with the process of the code itself. I know now that the my patient would not have been coded had I acted more appropriately on the information available to me. I do not necessarily believe that the patient would have lived had I acted differently, but had I done a better job of communicating with the family about their wishes when the patient began to go downhill we could have at least gotten a DNR order in place. I spent a whole lot of time thinking about what went well and what did not, and I have learned from the process. I think I've managed to get on the nerves of our cardiologists by being a bit hypervigilant, but better to be hypervigilant in the learning phase than to be undervigilant. Anyway, any shared experiences would be appreciated.

And one last thing. We have students on our floor now, and having gone through the first-time experiences of being in a code after starting work, I really want to invite students into codes so that the whole experience is less traumatizing once they have to deal with it on their own. Does this sound like a good idea? Should it happen, I would assign a role to the student (probably recorder, compressor, or ventilator), and direct the student as needed during the code. I know it is an intense situation and you have to act fast, but with adequate direction I think students can perform specific tasks in code situations without affecting the outcomes of the code (of course mileage will vary per individual).

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I think its a good idea to get students involved. In the hospital I work at the orderlies do compressions, but if a student is there... why not? As long as they are BLS certified. Good experience! When I was a student I once was let to do compressions (I honestly think cause this guy was practically dead anyway) and got a heartbeat back. I was so excited! Since then I've only done compressions once.

I've had 2 pts code on me... I've been a nurse for 9 months. And 4 pts die on me. Both of my codes died. :( I heard someone else who had been a nurse for a year say that she hadn't had anyone die on her yet. I was like Oh my!

Watching codes doesn't bother me too much. Its interacting with the families that gets me teary eyed. Only once have I really been affected with a code, because I had gotten to know his fam. I almost always throw in a lil prayer during a code. :)

My second week on the floor I had a pt go into respiratory distress. It was just me and the NA to manage it until help arrived which wasn't until we had the non rebreather on and O2 sats were coming up...I was shaking and sweating and the NA took me into the bathroom and let me express my anxiety. She rocks! I had one calm shift the next day and then the very next shift after that (the start of my 3rd week on the floor) I found my pt cyanotic and unresponsive, a Rapid Response ensued which quickly turned into a code blue. Same NA, took me into the bathroom and literally let me cry in her arms. She told me "honey, now you know how bad it is, I doesn't get much worse then two emergencies in three shifts!" I am on a med surg unit - apparantly a very busy one...

HA! I don't want to jinx myself (or my patients for that matter.....:bugeyes:) I will say, it is something to experience. By the way, my med-surg floor also has hospice patients.

I assisted with a code during my preceptorship my last semester of school. I thought it was a great experience, and I felt like I truly showed my mettle during it. I actually enjoyed the adrenaline rush, but I'm a little odd like that :coollook:

During my preceptorship as a student had 2 codes within hours of each other! It was a real eye opener, and it may be bad saying this, but it is is a good experience as a student. Your not really responsible for things, as your under guidance from the staff. I got to participate in both codes by doing CPR. Got to experience first hand on how fats a patient can crash----I was talking to one of the patients about sports, then the monitor tech came in to check as he HR had risen, then he went quiet and then we called the code! In a matter of seconds he went from laughing to Vtach.

Don't assign recorder to student. Even experienced people have a hard time with that.

My first 2 weeks after orientation I had two codes. I am glad we have RR because I inwardly freaked out when they happened. I work on a med-surg floor but we seem to have our share of codes.

I think its a good idea to get students involved. In the hospital I work at the orderlies do compressions, but if a student is there... why not?

orderlies? people still use that term?

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