First code experience

[emmjayy, BSN, RN]

I've been working at a hospital as an assistant for a few weeks and just had my first experience with a patient coding. I was helping another patient when the code was called. I saw a lot of other nurses, experienced LPN's, respiratory therapists, doctors, etc. running to the room so I figured I was not needed and finished helping my pt before going to the room and handing out PPE to the people who were still running up to the door (the coding patient was on precautions). I was able to watch from afar and it was very interesting, but I did not feel emotionally impacted in any way by it. I hoped that the patient would be okay, but when they continued to code and it became clear that they were probably not going to make it, I was not upset or emotional in the least. It was nothing like what you see on TV, no one was shouting or getting flustered, everyone just quietly did what they could as quickly and efficiently as possible. It felt very surreal to be seeing the event unfolding in front of me and I just tried to watch quietly and stay out of the way whenever I got a break from running around the unit covering call bells and things for the nurses who were in with the patient.

I am very surprised that I was not upset or really very much affected by any of this. I thought that seeing compressions/shocks/emergency intubation being administered would at least make me feel an adrenaline rush or shaky or tearful even (since I'm pretty new to the medical world and have never seen a patient in severe distress or close to death) but at the time I felt very calm and unaffected and I still feel very flat about it, if that makes sense. Has anyone else had this type of reaction to a code?

[Double-Helix, BSN, RN]

You weren't actively involved, and your decisions/actions didn't impact the outcome in any way, nor were you personally connected to the patient. So no, I don't find your lack of adrenaline or emotion surprising. Some people can better compartmentalize the medical side from the human side and seem hardly phased by even the death of their own patients. (I am one of them. I was involved in the code and subsequent death of 4 month old in the PICU on the first day I returned from maternity leave, and did not find it excessively distressing or difficult.) Others may cry or become emotional over any death. It's not right or wrong either way, just different ways of responding. I also think the prevalence of dramatic codes and resuscitations on television contributes to a kind of desensitization as well. I suspect that if you were an active participant in a code you might feel a greater sense of urgency or anxiety related to accurately performing medical interventions, but a well-run, organized code decreases those feeling as well.

[HouTx, BSN, MSN, EdD]

In my experience (critical care), codes are not characterized by shouting or drama. Participants are all well-versed in ACLS protocols & everyone is on the same page. In fact, I have had a couple of student 'observers' comment that watching the code made them realize that nursing really is a job. I guess that they also expected TV-type drama and a ton of angst. In order to thrive in a fast-paced, intensive setting, nurses must be able to effectively compartmentalize. Our job is to focus on the patient & we can't do that if we're caught up in our own emotions.

This does not mean that clinicians don't need emotional support. Smart organizations offer Critical Incident Stress Debriefing (CISD) as a normal process for staff who have been involved in codes or other unexpected events. THIS is where it's OK to "lose it" and let those emotions flow - in a safe and supportive environment.

[AliNajaCat]

I once had a student who was enormously affected by a death on the floor in the SNF where we had clinicals---of a patient he wasn't caring for, whom none of his classmates were caring for, and whom none of us knew at all. I mean, he was really upset, shaking, in tears. I pulled him of the floor for some gentle conference time and asked him if he knew why this unrelated death, which was not unexpected, was so upsetting. Was it something somebody said? Did the patient remind him of a relative or other person who had died, or might be dying soon?

No, no, and no... and all the while, really decompensating. I finally just said, "Well, why don't you go home and think about it, and journal it for your clinical journal this week."

Long story made short, it turned out that he had some fairly significant preexisting mental health needs, and he withdrew from the program. Sometimes too much reaction is a red flag.

If you were doing what you describe, that was a perfect intro to the situation. I would be somewhat surprised if you had no emotional reaction at all, but not if you explained to me in the way you did here. A thoughtfully mature approach to a novel situation; good attitude.

[emmjayy, BSN, RN]

Thank you all for your responses! I've enjoyed reading the different perspectives and feedback from people who've been around the block many more times than I have :)

[LessValuableNinja]

In my experience (critical care), codes are not characterized by shouting or drama. Participants are all well-versed in ACLS protocols & everyone is on the same page. In fact, I have had a couple of student 'observers' comment that watching the code made them realize that nursing really is a job. I guess that they also expected TV-type drama and a ton of angst. In order to thrive in a fast-paced, intensive setting, nurses must be able to effectively compartmentalize. Our job is to focus on the patient & we can't do that if we're caught up in our own emotions.

This does not mean that clinicians don't need emotional support. Smart organizations offer Critical Incident Stress Debriefing (CISD) as a normal process for staff who have been involved in codes or other unexpected events. THIS is where it's OK to "lose it" and let those emotions flow - in a safe and supportive environment.

It isn't like Grey's Anatomy where the staff of 37 physicians are the only ones in the coding patient's room, and are all simultaneously arguing about both the proper approach to save the patient and their failing relationships? So disappointing.

[grizun]

I've always been able to separate my emotions from the work. Often, after the fact, when the patient doesn't make it and I'm speaking with the family I'll feel bad for them, I empathize with their pain, but I've just seen so many die in front of me that it doesn't phase me, yet I don't think it ever did.

[MYSTICOOKIEBEAR]

Everyone deals with codes and death differently, I have a feeling that you will have a VERY different outlook once you are an active participant in one, but maybe not. In my experience, people only shout and yell if they either A) Don't know what to do B) Are not getting the supplies they need to carry out their duties C) Too many cooks in the kitchen (too many people saying things and trying to take the lead position).

You will be in a code eventually and knowing what to do and when to do it is crucial to being a successful member in one. I actually made a video describing the different positions in a code, it may help you in the future!