Coding

After ACLS is when I started to feel the most comfortable and had my first code. Once I REALLY understood what was happening, it made me stop and slow down and think more. Thats not to say I dont get a huge adrenaline dump every time, but now I feel like I can handle myself and help direct others more efficiently.

First take your ACLS, it'll give you the rundown of the different areas of responsibility (i.e. team leader, meds/access, defib, airway/bagging, compressions, recorder, runner).

Then, try to be involved in codes that occur, and focus on one area of responsibility. I think when starting out, acting as the recorder is great b/c you get a sense of the bigger picture. Airway usually gets handled by the RT/airway team once they get there. Ideally, once you understand and become proficient at the different roles, you'll be comfortable with code situations. Additionally, the strength of your other team members will play a role in how comfortable you feel. Be involved in codes with more experienced nurses and afterwards learn from them.

If it's your patient that codes, of course you'll be the one to start CPR, but as soon as people arrive and start to take over, let them. Step back and talk to the docs about what happened and start working on your differential diagnoses. Don't be that primary nurse that is unable to give a good description of what happened prior to the code b/c they are too busy pounding on the chest. It's a team effort, and your coworkers will help... your job will be to help figure out the cause as you will know the patient/hx best.

I am still getting there, but I have found it much easier (so to speak) when it is not my patient...

Recently was part of a code (that went really well) and was complimented by some others that responded - felt good, but it really was the team - when you have a great one, it makes all the difference.

It just comes with time and experience. However, always be confident in yourself and what you're doing, even if your skills aren't quite developed yet. Those will come eventually. However, being the nurse that's constantly scared and unsure of yourself will cause you a significant delay in becoming a better nurse. Being confident doesn't mean being cocky, it simply means you know you are smart and skilled enough to get the job done.

my one piece of advice in dealing with a critical pt. is its much easier to keep a pulse than to get one back. by that i mean be preventative, if stuff starts going down hill fix it before it gets to that point if at all possible. and when it does reach that point always stay calm and learn from the more experienced nurses.

You will be amazed at how much of a difference a good team leader can make. A frazzled team leader will make everything seem chaotic and you may have trouble following what's going on. When you are part of a code with a smooth, calm team leader, you will see how much more simple the process is than you thought.

Also: SLOW DOWN. My biggest problem when I was starting was that my adrenaline was pumping so hard that I was rushing around and my hands were shaking. I was so inefficient and I looked like an a**. If you just take a moment to at least pretend like you're calm, whatever you're doing will actually happen smoother and you'll absorb more of what is going on around you.

I 10 fold agree to this. If you have an amazing Code Leader/MD that knows what they're doing, then the code will run so smooth; regardless of the outcome. But if you have a a new resident on rotation or a fried out RN, then you can assume the outcomes and emotions of the code...

I've found that some floors assign CODE tasks at the beginning of the shift so everyone has a more defined thought of the major part they will play. Not to say that things wont change or rotate but you wont be dazed and confused. When I am resource nurse in the afternoons, I find this works well. Especially with new nurses or unfamiliar float staff in the mix. That way by the time the code team arrives, we are Rocking!!