New ER nurse

[BaileyBSNRN]

Hi everyone,

I am a new grad RN working in a community hospital's ED. I was involved in a very troubling code a few nights ago that involved a self inflicted GSW to the head by a police officer. During the code I performed cpr for close to 45 minutes while police in the room were watching and crying and several of the staff members were upset because they knew him personally. This was the first true trauma I have experienced and had trouble bouncing back from this afterwards. I was not overly emotional but I had trouble concentrating and felt very run down for the remainder of the shift. I kept thinking about the officer taking his own life... his family.... the whole situation with people crying, etc. I felt lucky that my preceptor and I were in the psych section of the ED that night and had already passed all of our meds and taken all of the vitals so I had some time to reflect. I had the following day off (thank god) and I felt very emotional and "out of it" for pretty much the whole day. I am hoping the hospital holds some sort of debriefing considering the situation and the fact that this was an officer well known to the department but I don't think it will happen. My question is, has anyone else experienced this after a code? And does it get easier to deal with? I do not want to lose my emotions but I also don't want them to affect me to the point that I can't concentrate at work... dangerous! I am hoping that this only happened to me because I have only been involved in a handful of codes. My fiancé is also in the medical field, (a PT) and I wish I could talk to him about some of the things I see at work (no hippa violations of course) but I know unloading this on to him will not make me feel better. Any advice on how you deal with traumatic codes would be greatly appreciated.

Thanks

[JadedCPN, BSN, RN]

Everyone's first handful of codes, especially traumatic ones, can always take a toll, and saying yours was a traumatic code is definitely an understatement. Not just a GSW, but self inflected, to the head, law enforcement, and known to the staff...wow. This is a perfect example of why debriefing should absolutely happen for staff after a code like this. It doesn't take away the trauma, but I feel if you guys would have had a debriefing then you may have been able to focus just a little better. And if a debriefing doesn't happen, this may be a great opportunity for you to be a change agent and ask for one going forward. Good luck to you.

[Gary Mendoza]

My question is, has anyone else experienced this after a code?

>>> Yes, I was in a small town ER once and a police officer came in after being shot by a pedophile they were going to serve an arrest warrant on. We worked him for over an hour and he died. We had the city police, the county police and a few state patrol there too. Lots of officers were there that day crying, angry and distraught. It was hard for me to hold back my emotions too.

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And does it get easier to deal with? I do not want to lose my emotions but I also don't want them to affect me to the point that I can't concentrate at work... dangerous!

>>> I can't speak for every ER nurse, but I've become very calloused about gunshots, stabbings, codes and serious traumas. They don't bother me anymore. Even though these things don't bother me anymore, I've noticed I've become more caring and emotional in my personal life. I think it's taught me to appreciate life more because I've learned it's a very fragile thing and can be taken from us with very little effort. So I spend as much time as possible with my loved ones.

- - -

I am hoping that this only happened to me because I have only been involved in a handful of codes. My fiancé is also in the medical field, (a PT) and I wish I could talk to him about some of the things I see at work (no hippa violations of course) but I know unloading this on to him will not make me feel better. Any advice on how you deal with traumatic codes would be greatly appreciated.

>>> Time and experience will make it easier to deal with death. It's like anything else, once you've seen and done it enough, you get better at doing it and you get better at being able to handle it emotionally.

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ER is a very hard dept., we deal with every medical situation because everything has to come through us before going to the floors (usually). It's not for the faint of heart. If you stay in the ER , it will change you. Over time, you'll be able to read people very quickly and things that bother you now will not bother you later. I've seen many people come down to the ER and end up leaving because it's a completely different beast from any other part of the hospital. If you decide to stay with the beast, you'll become one yourself, but not in a bad way.

[akulahawkRN, ADN, RN, EMT-P]

It's always tough to code someone you know, especially it it's a trauma code. I've been through quite a few (many I've run myself) and I can honestly say that I remember the first one, a couple of memorable ones (for various reasons), and the most recent one I worked. The rest are quite simply a fuzzy spot in my memory and I don't remember them all that well. If you do enough of these, you'll get kind of hardened at this and they won't affect you as much. You just do your job and keep going afterward. As Gary posted above, the ED is a different beast than any other part of the hospital and the nurses that work there become a kind of beast themselves. It also fosters a different kind of camaraderie because things just are that different.

If your hospital doesn't have some kind of formal debriefing process, you should be able to approach a chaplain or similar person there to do a debrief.

I don't pay attention to the news much these days (except the morning local news broadcast). I can guarantee that probably more than a couple of the codes I've worked as medic and as a nurse in the ED made the news. I actually don't care about that. I make my peace with those deaths as I know I have done my job as part of the code to the best of my ability and knowledge at the time. I look for ways to improve, but at the time, I'm doing my best. If the person's injury or illness is too severe for their survival, so be it. We can't, and don't, win all those battles. We provide a nudge toward life and often that nudge isn't enough. So we go on, learn from what we did and could do better next time and try to win the next one, futile though it may be.

[JKL33]

Hi Bailey,

Your emotions and your processing of the situation are normal and definitely understandable.

Please talk with your preceptor and/or manager and/or educator and ask if some time could be set aside for you to process this out loud. Also, don't assume that a community hospital doesn't have resources related to this; having a team that facilitates employee care is becoming more and more common, but if it's not available most places still do acknowledge this type of stressor and offer assistance with it. Please ask if your hospital has such a service or a usual practice that they initiate when an employee expresses a need.

Consider journaling, if that's something that might help you. Allow yourself to feel what you feel without taking emotional responsibility for those things that you can't control (such as death). Engage in self-care practices.

A ((hug)) for you ~