confused rn

Esme12, ASN, BSN, RN · Apr 28, 2014

Give it time.....it takes about a year to try to start to make sense of it all. In a code situation you re never alone.

cardiacfreak, ADN · Apr 28, 2014

Find someone with experience that you trust and confide these concerns to them. Ask them to teach you about the crash cart and the defib. Practice rhythm strips daily at home. Esme is correct you will not be comfortable for almost a year, and even then sometimes you still are not totally comfortable in certain situations. That is normal and okay. Just remember there is always someone you can refer to when needed. Have you taken ACLS yet? My very first code I couldn't even remember what the patient was admitted for. I felt totally out of my element, the only thing I did remember was to do compressions before the code team arrived.

inchii · Apr 28, 2014

Ask for help. It is good that you acknowledge the things you lack. But sometimes, it might be dangerous too. You can learn how to hook up a defib in a few minutes. Just ask someone, I'm sure they will be glad to help. I feel like you're a great nurse. Give it time :)

Cuddleswithpuddles · Apr 28, 2014

First of all, I do not think you are even giving yourself the opportunity to get past this. You say things like you do not know what to do, you do not know how to X, you WILL freeze up, you are only cut out for routine etc. as if these were concrete, permanent truths. They are not! :) If you do not know how to hook up the defibrillator, you can learn how to. You can study ACLS. You can keep looking at rhythms and analyze them until you are comfortable. There was once a time when you had to learn the basics of nursing like what is an abnormal blood pressure, how to start an IV and how to safely give oral meds. I bet you there was a time when you said taking on more than two patients was challenging. Now, I bet you do it all the time. There is nothing to say that you cannot learn stepdown skills like you did any other skill you have... except you! :)

delphine22 · May 2, 2014

Sounds like you have not experienced many codes. The more you see, the more you realize it's a team effort. If there is a code on your floor, and it is not your patient, HANG BACK. Or volunteer to do compressions (that's pretty hard to screw up) or relieve someone who's doing compressions. Or be a go-fer -- "Oh, you need more IV tubing? Be right back!" This gives you a chance to watch what's going on but not have any "real" responsibility to be nervous about. Usually one of the ICU nurses will push the drugs so don't freak out about that just yet. DON'T volunteer to be the recorder, at your first or second code it can be confusing, and you sort of have tunnel vision and can't really see the code for its whole picture.

If it IS your pt (heaven forbid) that codes, your job is to tell the code team what's going on with that pt -- their history, meds, last vitals, allergies, other pertinent stuff. That's ALL you are supposed to do -- be the knowledgeable person about your patient, something no one else on the code team can be. Absorb the code, get used to its own little routine. Depending on who runs it it can be smooth or chaotic, but the more of them you see the less scared you will be.

As for rhythms, make friends with the monitor tech. Sit with them when you have a few minutes. Look at the weird pts, even if they aren't yours, to see interesting rhythms. Skilstat is a lifesaver too: ECG Simulator | SkillStat Learning - Fast, Fun and Effective!

Any time someone has anything weird/difficult/rare going on, volunteer to help or just ask to watch and learn. You may not experience everything on the floor but at least SOMEONE does, so learn from their pts too. Again, the more often you see something, the less freaked out you will be when it happens to you.

Four months isn't nearly long enough. Newer nurses often have the feeling that they can't do this, they aren't capable of saving a life. But the whole floor works together. You are NEVER ALONE. Push the button, call the number, or just literally scream for help, and people will come running. And one day you will realize you know what to do, you've got this. It will happen. :-)

exp626 · May 2, 2014

I understand how you feel. As a new RN, I was asked by my manager to train with cardiac acute patients, which were fresh MI's who had undergone angioplasty and had arterial lines. At the same time, I was asked to train for the code team for the hospital (a 600 beds). Those were the days before we had rapid response teams, so answering codes was a very real possibility any given day. I didn't feel at all prepared for this. I had taken ACLS, but it was a whirlwind and I was sure I wouldn't be able to recall anything meaningful in a code. First, I signed up to take a ACLS instructor class. What better way to learn it than to become an expert at it! I studied my ACLS books every day, and I became very proficient at it. I also didn't feel like I knew the crash carts or equipment, so since our pharmacy is the dept who puts the locks on the cart after they stock the meds, I called and asked if I could go look through one before they locked it. When my coworkers heard I was doing that, it turned into several of us going to the pharmacy. Our clinical educator caught wind of what we were doing, and she provided us with an unlocked mock crash cart for a few weeks in the break room. That helped free up a defibrillator for playing with. That was about 15 years ago, and now I'm "cool as a cucumber" when there's a code (even though secretly sometimes I still get a few butterflies in my stomach!). And one last thing...I can guarantee you're not the only one on your unit with these doubts, you're just more conscious of them! Not every tele nurse, even some of the seasoned ones, is comfortable in emergencies. (Disclaimer: I was an LPN on a tele unit for a year or two before this, so I did have some experience. This may not work for everyone, but it did work for me. If you do this, prepare to put in some mad study time and run into every room where there's trouble to increase your exposure!)

delphine22 · May 2, 2014

I also didn't feel like I knew the crash carts or equipment, so since our pharmacy is the dept who puts the locks on the cart after they stock the meds, I called and asked if I could go look through one before they locked it. When my coworkers heard I was doing that, it turned into several of us going to the pharmacy. Our clinical educator caught wind of what we were doing, and she provided us with an unlocked mock crash cart for a few weeks in the break room.

What a great idea! We had a skills fair a few years ago that included a "hands-on crash cart," but it seems no one but the ICU nurses knows what is where (though I do know from experience exactly where to find the D50!). I will ask on our unit about doing this.

UnbrokenRN09, BSN · May 4, 2014

Cardiac nursing has quite a learning curve as I'm sure you've noticed already. You have to hit the books and really learn some things, then see it in practice to really get a good grasp on things.

Have you taken ACLS? The whole "code" thing never clicked with me until I took ACLS. After you get your certification, I recommend studying it from time to time between recerts to keep it fresh in your mind. Like others have said any time something interesting is going on with someone else's patients, jump in and help. You can learn so much by doing that. And the other nurses will greatly appreciate the help....when it's your pt that's crashing, it's stressful because you're the one trying to figure out what to do and putting all the pieces together, calling the doctor, putting in orders, etc so it's nice when your coworkers jump in and do all the technical stuff for you. Successful patient care is a team effort

But basically....learn ACLS. Learn all the rhythms and make sure you understand what the heart is actually doing in that rhythm and what happens as a result. Learn about the most common cardiac emergencies and what to do about them--MI (STEMI & nonstemi), cardiac tamponade, cardiogenic shock, PE, electrolyte imbalances causing rhythm disturbances (always know your latest mag & K on your patients). It will seem overwhelming at first and take time for you absorb all of these things, but one day it will all click and fall into place and you'll find yourself acting more on instinct without having to really even think about what to do.

You will panic and be all "deer in headlights" for your first few codes, but that's normal. Just make sure you call the code and get help on the way immediately. Start doing compressions if they don't have a pulse. Creat imaginary "worst scenario" cases in your head and plan out how you would react. Probably the worst case scenario I can think of is walking into a room with a patient face down on the bathroom floor, no tele on, unresponsive, & bleeding. That's about as bad as it gets (worst I can fathom based on experience anyway....knock on wood)

At least give yourself a chance to "get comfortable" with cardiac. If you still find that it's too stressful for you, then you can always do something different. Cardiac stepdown/ICU definitely isn't for everyone, just like people like me can't do med-surge...lol. To each their own....that's definitely a nice perk about nursing is that there's plenty of options to find your niche.

Anggach · May 9, 2014

Take it easy my dear.. it takes time. Been in this ICU thing for 3 years and still feel unstable sometimes. 4 months is way to soon to give it up. The guys above have covered lots and I need not repeat. Just thought I would drop a line in lieu of a hug...lol! If at the end of your shift your patients are still alive...it's a good day!!!