Don't really want to be Code Blue Nurse

sandyth · Feb 7, 2004

Once you perform your first code it will get easier, and youj will think faster on youjr feet with every code. plus at my facility we all pitch in.

RNPATL, DNP, RN · Feb 7, 2004

Originally posted by CCU NRS
You know this is one of the things I really don't feel confident about. I have done my credentialing and am not looking forward to being in charge of a code. I feel that I am pretty confident in most areas but this is just something I am a little (Ok I will say it) scared of! I don't really know exactly why but it is getting to me.

Any help apreciated:imbar

As a nurse, it important to face your fear. I felt the same way as you about dealing with codes. However, the best way to get a little more comfortable with the process is to jump in and be a part of the team and learn. I am not really sure that one is ever totally comfortable with coding a patient, but your confidence will improve one you work a few codes and remember the ACLS protocols.

fab4fan · Feb 7, 2004

Review your ACLS over and over...go to sites like randylarson.com; great ACLS learning site that is entertaining, too.

When I first went to the ED, I was terrified of the first code. We got a call the the medics were coming with a full arrest. The ED doc saw how anxious I was and took me into the trauma room and said, "OK, now before they get here, let's talk about what we'll need to do." Bless him...it really made my anxiety less.

No matter how many codes you do, there will always be that rush of adrenaline. After you've done a few you will fear them less. I actually kind of miss not being involved in codes any more.

Dinith88 · Feb 7, 2004

LIke everyone's said, it gets easier. In fact, you'll soon learn that it's actually very EASY if you're a team member and only responsible for one aspect of the code. (pushing meds, defib/monitor-watch, etc.)

Now, if you're responsible for 'running' the code, thats a bit different, but gets easier over time.

Where i work, the ICU nurse is tasked with running the code before an MD arrives(some of them can take their own sweet time!). If you're in the same situation, be sure you know your stuff! Otherwise, the best advice would be to get involved with as many codes as possible...before you get into a situation where you're "it".

Speculating · Feb 7, 2004

Originally posted by RNPATL
As a nurse, it important to face your fear. I felt the same way as you about dealing with codes. However, the best way to get a little more comfortable with the process is to jump in and be a part of the team and learn. I am not really sure that one is ever totally comfortable with coding a patient, but your confidence will improve one you work a few codes and remember the ACLS protocols.

All of the posters have been on the money so far. I don't know that you'll ever feel completely or are completely comfortable with a code (after all someones life is in your hands) and if you are something is wrong; however, your anxiety level will diminish with time. Feel safe though. Your not the only one there, and if you are then it's only right that you should feel uncomfortable :) There are a lot of checks and balances. Know your algorithms - know your drugs there aren't that many to have to memorize. It's very methodical. You'll be supernurse in no time!

CCU NRS · Feb 7, 2004

Originally posted by Dinith88
LIke everyone's said, it gets easier. In fact, you'll soon learn that it's actually very EASY if you're a team member and only responsible for one aspect of the code. (pushing meds, defib/monitor-watch, etc.)
Now, if you're responsible for 'running' the code, thats a bit different, but gets easier over time.

Where i work, the ICU nurse is tasked with running the code before an MD arrives(some of them can take their own sweet time!). If you're in the same situation, be sure you know your stuff! Otherwise, the best advice would be to get involved with as many codes as possible...before you get into a situation where you're "it".

Yeah this is the deal, In the CCU if we code someone there is lots of teamwork and many experienced code blue nurses.

At my facility we also have the one Code Blue Nurse per shift who is responsible to go to and run any code elsewhere in the hospital, so if there is a code on the 8th floor then you are the person running the code officially, of course once a Doc arrives you are not going to overide her/his decisions unless of course you feel they are following the wrong algorithm or otherwise baffled but you are still the responsible party to keep things running and following the correct sequence of events and ultimately it will fall to you to get the job done. When you arrive you assign chest compression and a med nurse and attempt to get things moving in the right direction.

We officially go on three codes with an experienced Code Nurse and then we are on our own.

Thanks everyone for the input, I guess time will tell.

rstewart · Feb 7, 2004

First of all I admire this poster's willingness to share his feelings on this subject. And I know for a fact, he is not alone.

I have often expressed my concern with the way ACLS has been taught recently. Simply put, in my opinion today's ACLS content and "style" represents a vast improvement for the provider who does not have to be the code leader. But for the new critical care nurse whose job calls for frequent leadership during the crucial first 10 minutes of an actual code---- it's a sad, sad joke.

Passing ACLS used to be a kind of "right of passage" for critical care nurses. You were not going to pass unless you knew the material thoroughly; you had to get it right the first time. The courses were more comprehensive as to what was taught and what was tested. There were lectures as well as hands on teaching. And there were megacode practices prior to the course which everyone had to attend----not because they were mandatory per se----but because everyone knew during testing their coworkers would be watching, that one missed pulse check would result in a retest the first time and failure the next, that you needed to overcome this obstacle to keep your job..........

Now at my facility one can even take their initial ACLS all by themselves on a computer. No pressure, no stress------just take your time, find out the order of interventions the computer is "looking for", a click with the mouse....and a new ACLS provider is born.

There are no easy solutions. The NCLEX, specialty certifications and ACLS are not anywhere what they once were. They aren't tweeking the NCLEX, for example, just for "grins"-------people are passing at acceptable rates, but in the real world bad things are happening.

So what to do? First I would inform your manager about your feelings. Likely as not, your concern will fall on deaf ears. But at least you will know for sure that she has been told (once again, no doubt) that completing ACLS/credentialing is not enough as you assume your new role. Trust me---you will not be the only one who has expressed this concern.

Secondly, do explore the various ACLS materials commercially available. While I do agree that previous AHA ACLS textbooks were quite dry, in my opinion, the Provider Manuals have gone from bad to worse.

At this point the best thing you can do is to observe as many codes as you can-----but with a critical eye. Note the differences between a smoothly run code and those less so. Watch the leader's ability to lead---to establish priorities, to delegate tasks, to constructively critique/guide in the performance of tasks, to perform the tasks safely, to encourage attention to possible causes....the things beyond the algorithms, drugs and rhythms. Take mental notes and compare what you would have done and what the leader did-----and whether his/her actions were effective.

You should be aware that code leadership is NOT a core competency of ACLS beyond task delegation---and even that is often not evaluated/required for successful course completion. So have patience...with some extra work and time the anxiety will lessen.

hmccartn · Feb 7, 2004

one of my nursing intructors gave me this advice "think of it this way, they are already dead, anything you do for them in a code couldnt make the situation worse.."

CCU NRS · Feb 7, 2004

Originally posted by hmccartn
one of my nursing intructors gave me this advice "think of it this way, they are already dead, anything you do for them in a code couldnt make the situation worse.."

Well I guess if you look at it that way then maybe so!!! :roll

fab4fan · Feb 7, 2004

Originally posted by hmccartn
one of my nursing intructors gave me this advice "think of it this way, they are already dead, anything you do for them in a code couldnt make the situation worse.."

Wow...talk about a way of reframing a situation.

mattsmom81 · Feb 9, 2004

So true that ACLS was harder at one time, actually prepared a nurse for code leader role, and a good manager never threw the new ICU nurses into code leader role til they were ready...its a warm body approach today. Poor leadership is mostly to blame.

One thing I hate is arriving to the floor and everyone is sitting waiting for me. Nothing has been done with the patient.Sometimes code status hasn't even been addressed. It's important for ALL nurses to familiarize themselves with the basics of code protocols, know their patient's code status, and know what to do immediately. Waiting on the ICU nurse for direction is negligent IMO.

And if ER or ICU staff is 'taking their sweet time' it may be because they have their own coding patient.....we may not call a code overhead.