Today I started my rotation in the ED. I got the opportunity to be paired with an amazing nurse. She's a natural born teacher and made sure I got a lot of hands on. After assisting with getting a woman in severe respiratory distress stabilized, I walked into a code. I stood off the side quietly watching the chaos. The team work was awesome. I was only in the room a few moments before I was offered a whack at doing compressions. I agreed with hesitation because as bad as I wanted to help, I felt my compressions would mean nothing to a man who was at least 275 lbs ( I'm pretty small) . Once I got into action, I came to find it wasn't as bad as I thought it would be. Unfortunately, he didn't make it, he was already too far gone. My biggest concern is that in all the chaos going on around me, I was completely calm. I kinda feel like a bad person because I didn't feel anything... The nurse said it was a good thing that I wasn't all over the place, but now I feel like I might have some kind of mental disorder, Like my response wasn't normal.
So, I ask, is this normal? How did you make out during your first code?
My first code is the same as the last one (working in oncology & ICU, I've had a lot) -- I'm able to keep calm and focused during the code(s) and the rest of my shift. I can be there for distraught families no problem. But after work I can't talk to anyone, I need some quiet time to let it drift out of me slowly. No funny movies or "cheerful" things. I usually walk if I'm not too tired and/or have a long shower.
But you're definitely NOT a bad person because you didn't get emotional. If you did get upset about it at the time, you wouldn't be able to go to work! As a nurse you process it differently than you would as a family member or friend. You see it clinically and focus on the tasks that need to be done, you're separate from what is happening (I call it going into "nurse mode"). It doesn't mean you don't care -- if anything, it means you care a lot that you put yourself and your feelings aside in order to try and save someone's life. It's not easy to do. Be proud of the work you did & know that you did everything you could to help that person.
Make sure you take care of yourself after these hard experiences. You may have kept it together during the event and kinda went a bit numb, but it doesn't mean it's not affecting you underneath. Debrief with other nurses or chaplain and reflect on the experience. Get sleep, eat well, exercise -- be kind to yourself.
I really loved oncology (worked there before critical care/trauma). I did my BScN student placements there also (I requested it). It was surgical oncology (gyne-onc, urology, ENT) with some palliative. I learned SO MUCH! I enjoyed getting to know patients and their families/friends. A lot of patients would deteriorate quickly out of nowhere and we utilized the Rapid Response team quite a bit. I think that's what led me to critical care -- getting to know the "ICU on wheels" was fascinating to me.
But oncology is a special place and I worked with the most amazing people. I know it's not for everyone though.
In the ER, I have figured out which codes elicit an emotional response and which ones don't. If I come into a code that already going on (for example, EMS rolls in already doing compressions), I feel like you did during this code. I don't have a connection with the patient. However, if I had spoken with the patient and their family, it's a bit different.
The first code I saw/helped with was during RN orientation, and it wasn't my patient...I was in the room for something else & everything started. It was a barely-stable trauma pt fresh out of the ED. It was exciting and I was happy to do whatever... compressions, go get more fluids, etc. The pt didn't survive (and would have had a terrible quality of life if s/he had, honestly) and I'd had no relationship with them. I was just glad I got to help!
The first code of my *own* pt felt much different: It happened unexpectedly during a moderate sedation procedure, I had literally just been talking to the pt before we gave the sedatives, I was trying to figure out something in our new procedure documenting software, and the pt's HR was suddenly 80 then 40 and then 20...I'm drawing up & pushing Narcan and Flumazenil (which I had at the bedside, but neither helped) and trying to call for atropine & realizing I just need to call the code. When everyone walks in, they want to know what we need and what's happening and they're all looking to *me* (and the proceduralist, but he was doing CPR & the anesthesia resident was bagging). Ultimately we got ROSC & intubated the pt, but then the family withdrew care and the pt died a few hours later.
Long story short, it's easier to be a set of helping hands than the one 'in charge'. OP- it sounds like you had a great first experience, in part because (and I mean no offence) you had people there to tell you what to do. Having a good leader in a code serves this exact purpose: it lets everyone calmly try to do what needs to be done. I can't say that I was that leader in my first code and to this day I'd much rather be a 'helper.' [self-reflection is part of the nursing school learning process, right?!]
My first code happened this week. I've been a nurse for 3 years and am now often charge nurse on a telemetry/progressive care unit. I've called tons of rapid responses, transferred who knows how many pts to ICU who died right when they got there, but I had somehow not been around when a code happened on my unit. This pt was young, but very, very sick. He had end stage liver failure with an INR through the roof, and despite every fall precaution, bed alarm, close to nsg station, you name it - he acutely became very disoriented and jumped out of the bed onto the floor. I helped rush him down to an emergent head CT with the clinical advisor and he coded right on the CT scan table. YIKES. It felt like it was straight out of a TV show. There was definitely the "Oh, S***" moment when we saw the asystole on the monitor and noticed he was unresponsive. And, CT is not the best place for a code... suction wasn't close by, the code cart had to be hunted down... it was initially chaotic but then luckily it became well-run. My role was initially connecting the pt to the defib pads and ensuring the monitor was working right and answering questions since I knew the pt, and then as the code progressed I switched out doing chest compressions. And, because he likely bled out, he did not make it.
After the code, adrenaline was high and I felt a little high strung, but I was confident in myself and surprisingly comfortable with the whole situation despite the trauma that led to the pt's death. It was difficult to talk to the pt's family after. It was also a little stressful relaying the event as a newer charge nurse to the nurse manager, but even still, I felt fine, and felt weird that I felt fine. But then... more than 24 hrs after the code, when I had a day off from work, I took a drive and man... I felt weird. Not so much about the pt, but I felt like I was flooded with emotion when I thought about being grateful for having that day and I totally cried. I think some massive reality hit me about mortality in general. And, it didn't help I was wicked over tired, because night shift. I immediately called my whole family to say a quick "Hi," "I love you." But, I still felt weird that it wasn't a reflex, that I kept myself removed from my feelings for that long.
Basically, what I'm trying to say, is we never know how we're going to react. It's normal to feel a ton of emotion, and it's also normal to feel little to no emotion, especially in the moment. It sounds like you did a great job, and good luck continuing to work through hard situations
madricka, BSN, RN
123 Posts
My first code is the same as the last one (working in oncology & ICU, I've had a lot) -- I'm able to keep calm and focused during the code(s) and the rest of my shift. I can be there for distraught families no problem. But after work I can't talk to anyone, I need some quiet time to let it drift out of me slowly. No funny movies or "cheerful" things. I usually walk if I'm not too tired and/or have a long shower.
But you're definitely NOT a bad person because you didn't get emotional. If you did get upset about it at the time, you wouldn't be able to go to work! As a nurse you process it differently than you would as a family member or friend. You see it clinically and focus on the tasks that need to be done, you're separate from what is happening (I call it going into "nurse mode"). It doesn't mean you don't care -- if anything, it means you care a lot that you put yourself and your feelings aside in order to try and save someone's life. It's not easy to do. Be proud of the work you did & know that you did everything you could to help that person.
Make sure you take care of yourself after these hard experiences. You may have kept it together during the event and kinda went a bit numb, but it doesn't mean it's not affecting you underneath. Debrief with other nurses or chaplain and reflect on the experience. Get sleep, eat well, exercise -- be kind to yourself.