First Code/Death

akulahawkRN, ADN, RN, EMT-P · Feb 4, 2014

It's completely normal to feel out of place and not know what to do when it's your first code. I remember my first one. Most people do. The hardest part about it is realizing that you not only need to call a code (good job by the way) but that you need to actually do something about it. I've run a few in the past and I can tell you that doing ACLS on someone absolutely must be a team sport. It's darned near impossible to run a code all by yourself unless you're lucky enough to have a thumper.

For Paramedics, they're drilled and drilled on ACLS before they even take the class. Consequently, they have a pretty good idea what they need to do and when. They also tend to keep drilling on that stuff later, even if it's mental rehearsal of what they're going to do. If your only experience with ACLS is the class you took a few months ago and you haven't reheorificed it since, you're not going to really be ready to do it until you've been around it a few times. Rehearsal kind of primes the mental pathways for you so that when the real thing happens, you just have to do those reheorificed actions.

Even with all the preparation I'd had, the first couple times I worked a code, it was pretty rough. It has been a few years since I've run my last code, and the next time it happens for me, I expect to be quite rusty at it.

Where you're at is perfectly normal, and is a perfectly normal reaction to have. Eventually, you'll be the nurse that's seen it and knows what to do, and you'll guide the new nurse through their first code as if it were some routine thing.

TheCommuter, BSN, RN · Feb 4, 2014

I fumbled badly during my first code back when I was a new nurse. I even remembered one of my nursing coworkers shouting to me, "Do something!"

You can rest assured it will not always be this way. The confidence to participate in codes arises with time, experience, and practice (yes: the more real codes you do, the merrier). Practice makes perfect. Good luck to you.

Esme12, ASN, BSN, RN · Feb 4, 2014

Okay, I didn't think this would bother me as much as it does but I had my first patient die today. All my patients are kind of on the edge but generally make it out. I work in a cardiac unit that basically doubles as an ICU step down/Intermediate care unit. I've been lucky so far in 6 months of nursing (yes, I'm a newby) nobody has coded on me. However, this came out of the blue today on a patient I never would have guessed was in distress.
My issue? I have the certs: BLS, PALS, ACLS and a few degrees: ADN, passed all my BSN courses and working on my RN to MSN-NP, I also have a BS in Anatomy and a D.C. degree. All that to say I don't know squat in a code situation. I felt so incompetent not knowing where to begin and what was going on. Yes, I remember the parts/pieces but my ACLS class was videos by a paramedic talking using plastic dummies. How about you guys? Is this typical in a first code situation to stand back and watch? I feel bad b/c that's MY patient and I wanted to help not just do post-mortem care, I have knowledge not skills, and the other nurses know I've got background (albeit useless in this situation).
I will say this inadequate feeling is not specific to this situation. Heck, I've felt this way since day one but I've progressed a lot in 6 months I think (maybe not?). I'm just really tired of feeling helpless and only able to contribute 70-80% to my patients because I just don't have the experience or specific job knowledge. Sucks. I'm used to knowing what to do and that just ain't gonna happen anytime soon and I'm overwhelmed with learning bedside nursing AND advanced practice nursing. Yes, it all has similarities to what I already know as a D.C. but the information is used differently and the skills are vastly different. Thanks for reading my story...looking forward to hearing your experiences.

Welcome to nursing.....((HUGS))

Nothing quite prepares you for that moment when it all depends on you. This is one of the reasons I believe that all advanced practitioners NEED time at the bedside. Nursing is a unique career. Book learning and rationale only go far in applicable skills. It takes experience and time to master these skills.

We have ALL BEEN THERE. Lord knows that I have all been in that spot when I thought...I have NO IDEA what possessed me to think I could do this? What on earth are they thinking that they make responsible for these people. It's humbling. I remember one of the first times I was charge and all hell broke loose....I looked for the charge nurse....that experienced person who floats in and makes everything all better and it was to my shock and horror ...it was me!

My first code was a pedi patient....I was so overwhelmed and I knew NOTHING in those days we didn't even have PALS. I swore on that day I would never be under informed from that day forward and went to ICU with a passion to know as much as I could cram in my head so I could be like those nurses who came to my, and the patients, rescue. It's not that I did anything wrong I just didn't KNOW anything.

I commend you for admitting that there is much more to learn and it will make you a better nurse and practitioner!

Kudos to you!

Biffbradford · Feb 4, 2014

The thing is that YOU know the patient, the history, what meds they were on, the latest test results, so YOU are the one communicating with the docs, pharmacy, the family. Get CPR going and the first few interventions and by then help should be there to take over with the manual work. Good luck!

Kaltia · Feb 5, 2014

But the key is you did it! and after that first one it gets easier. First time a patient coded, I felt very lucky as that particular shift, I had a lot of very experienced people working with me. I had no clue what to do after I called the code. It come to you bit by bit though. We're doign CPR and residents/respiratory have just made it in and I know I need to summarize this patient that I suddenly can't remember anything about. and I feel absolutely frozen so I glance over towards the foot of the bed where one of the other girls is already recording completely unflustered like this was every day and it was just so bracing to have support that had done this before. So I manage to briefly report the patient's info and situation and it worked. You don't have to be perfect your first time out. I felt like I did horribly that first time but the next one was a TON easier. Still nerve-wracking, terrifying. You can't do a code by yourself, know your patient and don't be afraid to ask for help. A code is called so you can get the help you need when you need it.

You sound like you did just fine for a first time. the confidence will come with time.

Mr Sacdiff · Feb 5, 2014

I am surprised you've made it this far in your education and just now had your first code, but do not beat yourself up. I'm still in nursing school, but I am working as a CNA. In just over a year I've been apart of 4 codes. The first 3, I simply just ran for items that might have been needed or simply observed from afar if I was allowed. One code was particularly bloody, so I simply tied face shields on everyone involved. My latest code, I actually helped with compressions and we saved the person's life (amazing feeling especially since the first 3 died). Anyway, I know I'll be judged because I'm "Just a CNA", but my point is that I've seen several nurses panic or take a backseat in a code. It seems to be quite normal. Like others said, everything comes with practice.

My novice advice would be to jump in and do what you can. If you screw up, someone will let you know and you will learn. Good luck with your career and your education. You will do great!

ncaru01 · Feb 5, 2014

I am an ER nurse, have been for over 3 years. I still don't feel completely comfortable in a code. I feel a lot more comfortable than I did. I realize what things need to be done for the most part. I am uncomfortable with anything I don't do on a monthly basis. I have a few patients that stay with me a bit. Most of the time I am not bothered by it anymore. I thought the ED nurses were callused and cruel and they kinda have to be. If I am going to see someone die a few times a month I can't spend weeks thinking about it. I saw one code at a rehab hospital when I first got out of school and there were nurses that were 30 years in and were borderline clueless. Class doesn't really prepare one that well for those high stress environments. When I take a critical patient to the ICU I prefer to have a medic with me because they are used to defibrilating and making decisions on their own. I could probably do it but I am more comfortable with someone that does it regularly.

TheCommuter, BSN, RN · Feb 5, 2014

I saw one code at a rehab hospital when I first got out of school and there were nurses that were 30 years in and were borderline clueless.

I have been working at a rehab hospital for the past few years and we only deal with codes every so often (read: a few times a year at the most). Since we do not participate in codes regularly in this environment, some people might seem clueless when one does take place. It is the result of a lack of familiarity.

I am surprised you've made it this far in your education and just now had your first code, but do not beat yourself up.

Although this doesn't apply to the OP, those of us who have never worked in an acute care hospital simply do not see many codes because our patient populations tend to be more stable. My first code took place about six months into my first nursing job.

suanna · Feb 5, 2014

Even as a seasoned critical care nurse- (almost 30years) I still can "freeze up" in a code; especialy when it's one you didn't see coming. I suggest, if your policy allows it, you pick one task- Recorder, titrating drips, bagging alt with compresions... whatever you feel you can do well, and keep your eyes and ears open. A code has a certain cadence when its run well that you will pick up on very soon. The process isn't that complicated as long as you don't get overwhelmed by the chaos. Focus on what you know and feel comfortable doing. Keep in mind- 98% of all in-hospital codes don't go home (well-to thier eternal home maybe) so you can't really do much harm. As a personal policy I don't allow my patients to die until after I report off to the next shift. So far it's a rule I've managed to keep all but about 10 times in 30 years. I still get stuck going to other nurses codes but at least I didn't break the rule for me and my patient.

deenurse76 · Feb 5, 2014

I fumbled badly through my first code. I'm ACLS/BLS certified, but it's still scary that first time (and the second, third, fourth, etc.). My charge RN wanted me in the room for the experience (being a newbie myself) and I was terrified. Suddenly, the MD was barking orders at me and the next thing I knew I was doing compressions when all I'd really wanted to do was to find a safe corner in the very back of the room and hide.

My second code, I ran the defibrillator and passed out the meds. After a while, I got into the habit of lining them up because I knew what was coming next. My third code, I pushed the meds and took turns with the compressions. My fourth code, I did a little of everything and helped the RT bag. There was a lot of blood in that one. I'll probably remember it the rest of my life. Each time I do one, it gets easier and easier. Still scary, but not as much as the time before. I don't think I'll ever not feel a jolt of nervous terror whenever I hear the words "code blue," but I don't feel as "out of control" as I did in the beginning.

I guess it's true what they say: practice does make perfect (but, it's also kind of morbid when you think about what you're practicing.).

Biffbradford · Feb 5, 2014

It can be a little scary initiating the code. I had a patient who I was sitting up at the bedside for the first time after heart surgery. All was looking good. He asked for a sip of water, put the cup to his lips .... and he went into VTACH, eyes rolled back, and BP went to 0/0. Crap! One second he talking with you, the next second you're starting compressions. Yikes!