First Code/Death

Ruby Vee, BSN · Feb 5, 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.

At six months, it's normal to feel as though you're only contributing 70-80% to your patients. You don't have the experience. And it's normal to not know what to do in a code situation, certifications be damned. You were probably better off standing back and watching than getting in the way. The only way to GET competent in code situations, though, is to participate.

When YOUR patient codes, you will of course activate the code team -- or whatever they do on your unit. We run our own codes, other units do not. Once the code team shows up and you can get off the chest, you should be standing next to the patient's IV access pushing the code drugs. Since you've been taking care of the patient, you presumably know what's running through the IV access, how sensitive the patient is to its being interrupted and can ask (if you don't know) if that drug you're about to push is compatible. It's a relatively safe place to be -- you can see everything and watch everything and yet you're participating.

When someone else's patient codes, try to help out by being the recorder. It's another way to watch everything that is going on, and at the same time you can start putting together how things work and start anticipating what they're going to do next in this situation. Being on the chest is another relatively safe place to be -- you can see and hear everything and you already know how to do CPR, right?!

We've all been newbies. We've all been through our first code and most of us felt utterly useless during that code. (Sometimes multiple codes.) We've all felt inadequate to the assignments we have or the task at hand. That's all part of being new. You'll get through it. Unfortunately, the only way to GET through it is to GO through it. You're at the halfway mark of that first awful year . . . congratulations. It'll start getting easier now.

chiromed0 · Feb 6, 2014

Thank you for the wise words and I just have a few observations. The first being I am relieved to know I'm normal for a change. :)

Another is to the "CNA"...you will never hear me refer to you as "just" an aide. I would be sunk if it wasn't for nurses aides. I am NOT an egocentric person by a long shot so my attitude is right. I'm there to learn and yes, my journey is a lot of "fake it 'til you make it". However, when it's a real person that I'm learning on it gets a little strange.

One comment I think sums up a lot of what I'm going through in that I just don't "know" what I don't know so each new situation I "feel" like a dunce. I must fake it pretty good since I still have a job but fortunately that feeling drives me to get busy and get experienced.

I fully agree that advanced practice RN's NEED bedside experience. Nowhere else do all these things occur than in a hospital of some sort and to just do some observations and jump to NP is a disadvantage. I know a few who have but that is not me at all. I made the decision to "pay my dues" on my road to FNP.

I'll take your advice and jump in next time. It didn't occur to me to be the historian in this situation b/c the attending physician was also the one who ran the code so he knew the patient much better than I. It was better for me to stand back and watch since literally 10 people showed up w/i minutes, luckily ICU is right next door. I guess I got flustered b/c I couldn't help but think about the fact I had other patients I had to attend to also. Thank You to all who replied and these accounts do encourage and direct me in my next experience.

HeartRN13 · Feb 6, 2014

I am so happy to read this. I'm one year into working on a cardiac unit and 2 years into nursing, and I still have never had a code. I think about this a lot and worry that I'd feel the way you do. Thank you for sharing!

Ruby Vee, BSN · Feb 6, 2014

One comment I think sums up a lot of what I'm going through in that I just don't "know" what I don't know so each new situation I "feel" like a dunce. I must fake it pretty good since I still have a job but fortunately that feeling drives me to get busy and get experienced.
I fully agree that advanced practice RN's NEED bedside experience. Nowhere else do all these things occur than in a hospital of some sort and to just do some observations and jump to NP is a disadvantage. I know a few who have but that is not me at all. I made the decision to "pay my dues" on my road to FNP.

Those nurses who can admit that they don't even know what they don't know have potential to be great nurses. And that you're willing to get bedside experience before jumping on the NP bandwagon is even better. Kudos!

lxpatterson · Feb 6, 2014

I am also a 2nd career new RN (1yr) and work in medsurg and ER float. I think you did great to get help right away. My first code was in ICU while I was in school and I was lucky enough to have mentors who pushed me into it. I was literally forced to do compressions and pulse checks by staff who knew I was a rookie. My first few codes I put myself in a position to do compressions because it doesn't take a tremendous amount of skill to do right and learning-wise you're in the middle of the whole code scenario.

I think the actual ACLS algorithm is pretty straight-forward, but the shock and flurry involved in a code is really hard to get used to. I also think that it is a lot harder to cope with a code on the floor. An ER code, in my experience, often involves a VSA who you have no attachment to and comes into hospital literally as a corpse. Whereas on the floor you have already formed some relationship to this person, and unexpectedly they go from chatting and drinking to unresponsive. That's pretty traumatic. I hope you are doing ok and I am sure it will make you a better nurse.