Feeling incompetent after rapid response

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My patient was admitted for third degree heart block on tele. HR 20’s-30’s never sustaining in the 20’s and completely asx. They began to have longer and longer pauses with O2 at 75% hr sustaining 20. We called a rapid and the MD gave orders to push atropine (yes it doesn’t work but why not try something). I’ve been a nurse for six months and I’ve never given it. I pulled it but had my charge nurse give the atropine. I’ve also never ever paced anyone so my charge nurse also did that. The only thing I did was get a manual BP and answer docs questions about my patient. I feel extremely useless and embarrassed. The tech got the ekg as well so I didn’t even do that. When do these feelings end ? :/ when did you start to feeling confident with cardiac rapid responses and knowing how to pace/shock them if that applies. Thanks 

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Specializes in Mental health, substance abuse, geriatrics, PCU.

I don't think you should be embarrassed or feel useless. Sometimes in rapid responses and code blue situations the assigned nurse will do certain interventions but a lot of times their role is to provide information the doc, looking up labs, vital sign trends, meds received, intake and output, and whatever information the doc may need from the chart, in addition to doing the documentation for the rapid response. Typically this scenario happens when you have really good team work and support with people assisting with doing interventions allowing you to help the doc piece together what's going on and what needs to happen. It sounds like you had good support from the tech and charge nurse, so that's great!

The only way to ever become comfortable with a procedure, skill, etc. is to do it. Observe the procedure, read your policy the procedure, and perform procedure with supervision. Communicate with your charge nurse or preceptor what you would like to learn how to do so they can go over it with you. Where I've worked in order to pace or do synchronized defib we used the same defibrillator used during codes, not sure what you use at your facility.

You become better at emergencies as you get exposed to them, just takes time.

Sounds like you did great!

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Specializes in CCL RCIS.

Im a new grad in the cath lab,  here's my advice: 

First off it sounds like you did a great job.  Did you get to see the pads get put on and your charge nurse flip the switch to pacing?  If so, great that's pretty much how you do it!  What you can do in your free time at work is fiddle with the Zoll or what ever defibrillator you have. Ask a seasoned nurse who knows it well to show you all the gadgets and tricks on it.  If it's a Zoll practice swapping in to manual mode and switching to the pace tab. Touch the mA and rate PPM dials. You can also go over your code drugs in your spare time.  Atropine, epi, neo, amio. Etc. Doses, indications, Contraindications. Once you know when to use these and what dose, you might feel more comfortable to give them.

You can't be expected to pace an unstable 3 degree heart block 6 months in with out a little guidance from someone who has been there and done it.  That's totally appropriate for your charge nurse to hop in and show you the ropes.  Next time you will get to do it!  Same with the atropine, it's commendable that you understood that you were not comfortable giving the medication,  next time you will be!  Its see one,  do one, teach one not do one, see one,  teach one Haha! 

Best of luck to you!  This is a great experience, consider your self fortunate to have a great team you can rely on!  

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I was able to put dfib pads on and grab the dfib. I also placed the pacing leads on and ekg leads but never pushed buttons. But I’m very thankful my charge was in there ASAP cuz I wouldn’t have known how to use the dfib at all! Thanks for the feedback 

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Specializes in CICU, Telemetry.

If you don't work in an ICU, and you don't have more than 3 years of experience....

You did MORE than I would have expected you to be able to do. You identified that longer pauses/lower HR than previous was an issue, checked the patient's blood pressure and evaluated your patient, and got your charge nurse and notified/got the physician to bedside. Heck, you even put pads/leads on and got the defib and/or code cart and atropine. Believe me, your charge nurse would have wanted to know about the change in your patient's acuity level right away even if you felt like you had it covered. 

Plenty of nurses I've worked with on telemetry have experienced this and failed to realize it was an issue that required immediate action. Plenty still have not told their charge nurse (me) and made me feel like a real idiot when an RRT is called and I didn't even know anything was going on. 

Needing a few other people to help out when your patient deteriorates quickly are the reason that we have charge nurses, rapid response, and code teams in the hospital. Even in ICU and with 10 years of experience you won't be able to transcutaneously pace your patient, give atropine, get an EKG, and communicate with the team all by yourself. You just simply don't have 8 hands and 4 brains. 

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Technically you can. I have done this in a Covid room, gave the atropine first (no dice), placed the pacing pads on someone and then placed the 12 leads electrodes while my resource nurse was filling up the info on the EKG outside the room. Once the patient data was in the EKG the resource passed the EKG machine to me while she PPE'd I attached the EKG leads and printed it. By the time she was done donning PPE we were ready to pace. All this within I would say less than 2 minutes and the intensivist took at least 4-5 minutes to get to the room. We had already started pacing by the time he got there. Pt was a little uncomfortable after she regained consciousness. 

But both of us have over 10 years CVICU experience. I would suggest watching educational videos on Youtube on pacing, ACLS medications. Watch "ICU Advantage" by Eddie Watson. He has a lot of good videos and information. 

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@awaiting new name can we pace on a med surg floor without orders ? 

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

Isn’t the rapid response team experienced in those actions? Or does “rapid response” just mean “get somebody here in a hurry”? Guess it depends on the facility. 
You did fine. Next time it will be easier. 

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Specializes in Rapid Response/Vascular Access.

As a rapid response nurse, it sounds like you did great. You recognized an issue/change in pt condition, notified RRT and got help. When I arrive to a rapid call, I can direct flow of activity and interventions. I want help from the nurse to do tasks, but especially want information. I have no idea who this pt is, what their history is. Activities and interventions are a "team sport". Your knowledge of the pt is not... That's what I need most from you. (I also welcome any suggestions you may have that I haven't said out loud.) Don't ever feel like you are in our way, or not helpful enough. We are there to assist you and your pt. For future events, after the event, remember to write down things that you didn't understand or didn't anticipate. Look up or ask someone to teach you about them. I carried a small notepad in my scrub top and wrote down anything I wasn't familiar with for the first few years of ER nursing. Look them up when (if) you get downtime. You will do great. There is a huge learning curve to nursing and you can't expect to be comfortable right away. I've been a nurse 6 years, but worked in our ER 10.5 years total prior to swapping to Rapid Response and I still have cases that throw me for a loop.

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I just got an offer for Cv telemetry, Its nice to read forums like this. I hope I will get some tips, know what to learn to become a skilled and better nurse one day! Thanks guys, I appreciated you taking time to write feedbacks for your fellow nurses.

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