There is nothing that gets your adrenaline going more than a cardiac or respiratory arrest during your shift, especially on a patient you were just going to do routine vital signs on...what do you do? Everyone has an initial fear, but it's how you work through that feeling, that can save lives. Nurses General Nursing Article
Code Blue (cardiac/respiratory arrest) events in-hospital can be really scary, especially if you work in the Medical-Surgical or procedural areas because they are so unexpected (most often, I should say.) I remember my first code quite clearly: a coworker and I were in a double room, helping to admit a relatively healthy (by transplant unit standards) patient, and as we were walking out to finish up the admission paperwork, we saw the patient in the first bed take his last breath. This man was not well, but we did not expect him to go into cardiac arrest!
We both froze for probably 5 seconds, but it felt like forever, and another nurse walking by saw the scene, called out for help and ran to get the code cart, shouting at us to start compressions. She knew what to do and got us all doing what we needed to for the patient, and then we worked as a team. The code team showed up and took over leading the code within a few minutes and it was as if our hesitation didn't matter (it ultimately had no negative effects on the outcome of the patient), but it did matter to me. I have never felt so horrible about not knowing what to do like that very day, and I vowed that I would never let a patient down because of my own fears again, and I haven't. I have overcome my fear, I actually love responding to codes, and I now train others in how to respond to codes...and hopefully take the fear out of it for them too!
I know that fear of the coding patient, but I also know that while you don't have to be an adrenaline junky like me, you can train yourself to work through that fear you have the first few minutes because you can start to think of a code like changing a dressing over a wound: there are certain steps that need to be completed in order. Sounds to simple? I promise, it's not. And, if you have Advanced Cardiac Life Saving certification along with Basic Life Saving, that's great, but we all have that same adrenaline rush (or 'fear') for the first few minutes, no matter how many certifications we all have, we are still humans and responding to the unexpected life or death situation, right?
Breaking down codes into roles, and having situational awareness of it all will help you to feel confident in your skills during a code event. Based on the American Heart Association's guidelines, the roles of responders can be clear, concise, and very simple:
*switch roles with the compressor every 2 minutes
*It sounds silly, but a lot of people turn it on and feel that their job is done....it does need some human interaction and critical thinking skills, like not defibrillating a patient with a pulse.
Assist as runners to obtain items that may be needed outside of the room, make any phone calls that may be necessary/requested, and help the code team find the room!
For the first few minutes of a code, this is all you need. You are helping the patient to circulate blood, you are maintaining their airway, and trying to restore circulation through defibrillation (if necessary). When ACLS trained staff/the emergency response team arrives, medications may need to be given, so the patient's primary nurse should stay with the code team leader to give vital information about the patient so they can figure out why this happened and how best to treat it.
Running away: I understand the whole fight or flight response, but don't fly....please? You need to be there for your patient; fight through it!
Switching roles without communicating: If you need to switch roles for some reason, communicate with someone else in the room to make sure they are taking over your role (maybe you don't feel comfortable with the AED, or someone needs you to take over compressions, so communicate clearly that they need to cover your role).
Yelling: You can communicate best by speaking, and people respond best to clear and concise communication, as opposed to yelling.
When you walk into an emergency situation, think of the roles of responders, and as each action as a task that needs to be completed, just like any other routine care of a patient, and you will slowly but surely overcome your fears. You have the skills and you can put them into action, so be confident in your competence and keep saving lives!
Learn more in Part II of this topic!