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First code

Hi all! Let me start by giving you a little background about myself. I am a new nurse, off of orientation for 6 months now on a busy ortho-surgical floor. I had my first code last night, which the patient did not make it. I am having a hard time dealing with this. The patient was older, with a laundry list of co-morbidities. Family was grief stricken, but were not completely caught off guard because the patient had been sick for awhile and only getting worse. Death was ruled cardiac arrest and found to be natural causes. I am just having a hard time with this. Is there something I missed? I just feel that something needs to change in nursing. How are we to notice of a decline, with 4-5, sometimes 6 other patients to care for? We are a non-monitored unit. I work night shift, so sometimes the slightest changes are hard to notice when someone is sleeping. Vitals, bs, and labs were normal. H&H was a little low, but doctor was not concerned. I have been struggling with nursing in general (patient ratios, amount of pain meds given, short staffed, etc) and now this makes me never want to return:(

Kitiger, RN

Has 40 years experience. Specializes in Private Duty Pediatrics.

I think you know that death is a part of life. It sounds to me like you're wondering whether it was your fault that your patient died. I remember one of my first codes. My coworkers wouldn't let me go home until I could agree with them that I "done good". "You done good, Kitiger, you did your job, you did your best. Now, go home and be nice to yourself."

What they said was less important than the fact that they said it. They were nurses, and they knew what it felt like.

Have you found a nurse confidant yet? You need someone who understands from a common background, someone who's been there. I know we have to be careful, but you can talk about your feelings without breaking HIPAA.

First off, *internet hugs*. Codes are hard and stressful period, and I think almost every nurse will second guess themselves after a patient passes.

My two thoughts are a) does your work offer debriefing/ counselling for employees after traumatic incidents? Can you debrief about the code with your educator or picc or someone who understands nursing? You will be amazed how much it can help to get your frustrations and worries out in the open.

My second though is not a criticism but a point to think about. With so many co morbidities, did the physician have a code discussion with the family? Some physicians are great with keeping on top of it, some it's like pulling teeth to get them to change the code status. It can make these scenarios less traumatic.

Well comorbidities do not equate to an automatic DNR. We have patients who should be DNR and they sometimes aren't - there are other factors influencing that decision that may reside outside of the actual medical diseases.

First codes are never easy - my first code didn't survive, either. No one gave me a pep talk afterwards, but I knew not to beat myself up because I always maintain a professional distance. Otherwise, you go home with such heavy baggage. I had a patient who never had any kids, no family members around, and I could tell they were very lonely in their room. And I saw my future. I'm gay, I'll never have children, etc, and it was such an emotional moment for me that the drive home was me just thinking about my life as an elderly patient. I had to stop myself from thinking about it because it was consuming me.

Yea, to an extent. My manager said I did really well. Which coming from her, is a huge compliment. I do have someone that I talk to, but I keep a lot inside. I don't like to bother others with my burdens. I try to confide im my husband what I am feeling, but he isn't a nurse. He is a steel worker and has the "suck it up" mentality.

That I am not sure of. The patient was not very old, but had a lot of health issues. Patient came to me from ED about 2330 and the PCP is out of the country, so it was a physician covering for him that wasnt familiar with the patient. Regardless, I dont think the family would have changed the code status.

One thing we have to accept is that we can only give our best. We are not gods that can stop death or change fate. Everyone dies.

You did your job to the best of your ability. Would it have made a difference if you had only had one patient and could have watched for subtle signs of degeneration? Maybe, but maybe not. Maybe there weren't any signs or maybe there were but you still couldn't have stopped them. Maybe it was just that person's time.

You can't control everything.

akulahawkRN, ADN, RN, EMT-P

Has 5 years experience. Specializes in Emergency Department.

My first code was back in 1997, he made it. Since then (and through a number of career changes) I have participated in over 30 (around 20 as both an EMT and as a Paramedic where I ran those... and about another 10 or so as an RN over the past 3 years. I'm an ED nurse and we get codes relatively frequently compared to other departments simply because of what we do. You'll remember this one and over time you'll find that you also remember your most recent but the rest will kind of fade to a blur. It's a good thing you have a nurse to confide in, though if you have a friend that's a Paramedic, that's another resource because they've likely been in your shoes a few times. Second thing is that you need to discuss your all your concerns about this particular code with that someone. Don't be afraid that the next time you go to work you end up working another code. Most inpatients aren't at that high a risk where you'd get one every night.

This next bit of advice is that you need to accept that death happens to everyone. Make peace with it. Our job is to try to keep patients alive and when they die, our job is to provide a nudge back toward life. All of our high-tech fancy technology in running codes amounts to but a nudge toward life. If it's the patient's time, if the patient is too sick or too injured, there's nothing that we can do to prevent that death.

Lastly, learn from every code you are a part of. It helps you get better and better at it and provide just a bit more of a nudge toward life. In the meantime, it's ok to grieve this loss in your own way. It was your patient, you got to know this patient and the family. Most of the time when we get codes, we only get to meet and comfort the family, so in a way you're in a better place to help comfort the rest of the family.

HeySis, BSN, RN

Has 25 years experience. Specializes in PACU.


Your first death, your first code. These are difficult things to deal with. It's good that you look and ask yourself if something could have been done different, this kind of introspection makes us grow, learn and become better nurses. But that is much different then beating yourself up, blaming yourself or otherwise feeling like a failure. Please STOP doing that!!

The fact is the survival rate for in hospital arrest is low, like 24%. Cardiac Arrest Statistics (It use to be lower, when I first took ACLS, we were told we practiced on nine to save one, because only one out of ten survived) The people that survive to discharge are not normally the "older person with lots of co-morbidites". It is hard to bring a young, previously healthy person back from the brink, when people get older, more frail, more ill.... the job becomes tougher, with worse quality of life if successful.

You did the best you could do, that is all should ask of yourself. Take time to de-brief with your manager or another person that was there. And then go home and be kind to yourself.

I get that we cannot control everything. Death is nothing new to me, unfortunately. I have also been on the other side. I lost my mom and grandmother in 2012 and my step-dad in 2014. I have been involved in codes previously, just not as the Nurse of that patient. Just looking for some release. I have had 1 hospice patient pass under my care, this was my first full code that passed under my care. It is just not a good feeling. Another issue is that after the code was over I felt alone in what I needed to do next. I had no assistance from my charge nurse. had to call the coroner, lifebanc, didn't know how to print the death packet because they just changed how we do things in EPIC. Plus help deal with the family. I know this was my patient and situation to deal with, but as a new nurse it was a lot to handle. It was just overwhelming with 5 other patients to care for and what didnt help was this all happened 2hrs before shift change and dealing with the thoughts running through my mind of "Did I do everything right"? And I hate to say it, but my daughter had volleyball practice that morning and I didnt want to let her down by being late. I just felt like I was being pulled in all directions. Please don't take anything I say as being insensitive. I have thought about this everyday simce it has happened.

OyWithThePoodles, RN

Has 10 years experience. Specializes in Med-surg, school nursing..

My first code was a 92 year old lady, sadly she was a full code. It wasn't my fault, and happened at the end of my shift but I cried and cried, so much so they called my husband to pick me up because they didn't want me to drive home. My manager and educator both came in after hours to comfort me...I'll never forget that. They cared how I felt, and wanted me to know that this was part of nursing. That I did nothing wrong, and they weren't going to let this get me down to the point of not coming back. (I had previously worked in a clinic, where codes don't happen. I told him I didn't think I was cut-out for the hospital) The doctor even called me the next day to reassure me that it wasn't my fault, but I still felt like crap, and you will. But you will be stronger for it.

You won't forget your first code. Take comfort in the fact they ruled it natural causes/cardiac arrest, that there wasn't much more you could have done.


Ruby Vee, BSN

Has 40 years experience. Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

My first code was in 1977. The patient was in her 90s, had a breast tumor the size of a grapefruit and about a dozen other issues. Her last recorded temperature was 104, and that was about 10 minutes before I went in to check her after having been alerted by the NA. When I started my very good quality CPR, I broke every rib in her chest. (At least, it felt that way.) She died. At the end of my career now, I can look back and see that her failure to survive that code was a blessing, but at the time, I felt exactly the way the OP describes.

Death is a part of life, and we all have our first codes. I hope that someone had the presence of mind to hug you as someone hugged me forty years ago. If not, please accept my virtual hug. ((()))

You did your best, your manager said you did well. If there's no formal debriefing where you work, debrief yourself. Take some time and sit down with a blank sheet of paper (or computer screen) and write for twenty minutes. (If you don't know what to say, write that.) Get your feelings out, take some time and think about what you could have done better . . . called for help sooner, started CPR quicker, checked labs earlier in . . . whatever you can think of. File that away so you'll do better the next time. Even if you did GREAT, you can always do better the next time. Writing has always helped me.

And remember: The first pulse to take in a code is your own. (Samuel Shem, "House of God")

HeySis, BSN, RN

Has 25 years experience. Specializes in PACU.

And I hate to say it, but my daughter had volleyball practice that morning and I didnt want to let her down by being late. I just felt like I was being pulled in all directions. Please don't take anything I say as being insensitive. I have thought about this everyday simce it has happened.

I don't think that's insensitive at all. It would be foolish to think that when we enter our workplace and put the nurse hat on that we take off every other hat we have (spouse, parent, child, friend). I've been in nursing for about 25 years now, it's been a running joke that you can't let someone die because it's too much paperwork. (some may feel that dark humor is insensitive.... dark humor is how I deal).

It's too bad there wasn't anyone that you could have asked for help from in getting everything done and in order, it's hard to do all that if your not familiar with the system, even if it's not your first code.

Thank you for your encouraging words amd not making me feel like a horrible person. I am just taking it one day at a time. Had a small emotional break down yesterday before work. I am really struggling with nursing and the stress and demand it puts on us. I am afraid to talk to my manager and others at my facility. I fear I will lose my job, be judged, and not receive the support I need.

See if you can find a kind and non-judgmental doctor involved in the case and ask him or her to review the code and events leading up to it with you. Failing that, maybe an experienced and knowledgeable nurse. Understanding the situation and its complexities is good for you and good for your continued practice. Second guessing everything you did and getting no answers is not.

For a while, it was pretty common to have a huddle and debriefing after a code or other serious event. I know some places still do these, but it's often fallen by the wayside it seems. Which is a shame. Because when done right, they help staff recognize things they could do better, things they did well, and things they ultimately had no control over. They help newer medical professionals especially deal with the realities of the job and not feel traumatized when bad things happen to sick people, as they inevitably do.

You do your best, learn from it, and let it go. That's all any of us can do.


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