First code as a new nurse

  1. I've been a nurse less than a year and a few days ago I experienced my first code. Two or three weeks ago we had a pt where a code was called but it wasn't a true code, even then I was terrified and fumbled as to what to do. This time it was my patient.

    I was in the med room pulling some meds for another pt when a tech came in and said my pt was complaining of chest pain. So me and another nurse went down to the room and to assess the pt, we did vitals and had a stat ekg done and labs drawn. Long story short, he then coded. I again fumbled and just searched for something to do and felt so helpless, so I just reached for the ambu bag and tried to quickly get the tubing unraveled and it seemed to take forever to get it hooked up to oxygen. When other nurses and more helped arrived, another nurse told me to record. So I started to write stuff down and then another nurse asked If I had recorded before and I told her I hadn't, so she took over. So during the code I just observed and went and got supplies as they were needed. I felt so horrible, standing in the back and this was my pt whom everyone else was trying to save. I always hesitate in new situations and scared to make the first move. When it was all over, my patient didn't make it. The rest of the night I kept running through my mind the whole situation. I kept wondering if the other nurses thought any less of me, in my mind I was thinking if your not doing something to help then get out of the way. Even now, I keep thinking before the code was called I should have moved faster and done things differently.
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    About Katniss0813

    Joined: Jul '11; Posts: 163; Likes: 79
    from US


  3. by   Christy1019
    It sounds like you are working with a pretty knowledgeable and cool team. Don't beat yourself up, it was your first true code so the best thing you could do was to observe and if able, jump in and do compressions. Have you taken ACLS yet? If not, being in a code situation can be confusing as you won't know what algorithms to follow. You assessed the chest pain immediately and did the proper interventions. Getting comfortable with codes takes a lot of time and experience, maybe you can speak with someone who was in the code and get their feedback as to what else they thought you could've/should've done as I was not there and do not know the full situation.

    Cheer up, you will get the hang of it!
  4. by   Lev <3
    Sounds like you did just what you were supposed to do. You assessed your patient and implemented appropriate interventions. With time, you will get more comfortable.
  5. by   rnhooch
    OP, I feel as you do. I tend to freeze up with new things and I am petrified of the thought of a code or RR...
    Christy1019, your advice was very reassuring.
  6. by   boogalina
    ACLS and more experience will help. Even if you take the live ACLS class, I recommend you invest $110 and take the AHA's online ACLS class, because it gives you the opportunity to practice the case scenarios over and over again until you feel more comfortable with them. Pilots work on the simulator, even experienced ones! So should nurses.

    Sounds like you did just fine to me - you allowed others to help you, and put your patient's needs first.
  7. by   Katniss0813
    I haven't taken ACLS yet. In school we did a sim lab where we did a mock code and I feel like I was supposed to know what to do, but I didn't react. The entire code looked like organized chaos. Before a bunch help arrived it was just me, two other nurses and a Dr. The Dr said epi pen, and I couldn't even figure out how to open the crash cart, then I couldn't open the case that had the meds in it because it had those stupid green zip tie things on it, I should have just ripped the thing open.

    My mind just seemed to go blank. I couldn't even remember back to my BLS certification. I seemed to just freeze and not know whether to start compressions or what to even do. I went to a code in the ED one day, but when I got there everything was under control so I just watched. Up until this time, I had never seen a code where compressions were started and the crash cart was used. I was so fortunate to have a great team of experienced nurses to work with.
    Last edit by Katniss0813 on Feb 2, '14
  8. by   Cal-Neva
    Confidence will come with time. It sounds like you all did the right thing, and you worked with a pretty good team. I don't know if anybody mentioned this, but if you are the primary nurse during a code situation and the code team has already arrived, then it might be best for you to not have a task anyway so that you can accurately give history and physical information to the doctor and code team. This is not a hard and fast rule, but something I feel can help.
  9. by   dudette10
    Every role in a code or rapid response is important. You were runner, which is extremely important to a smooth code. As other have said, it sounds like you have a very good team. Once you no longer have anxiety replaying the code in your mind, replay it with the intention of learning.

    I have been the primary nurse for one code (presentation exactly as you experienced, very sudden) and many, many rapid responses. In my facility, codes bring intensivist attendings, more residents than you can count, pharmacy, and nearly every nurse on the unit. I witnessed the code, so I, like someone mentioned, primarily provided status and background, observed, and wrangled family.

    It took some time for me to shake the code off, because it was emotionally draining as it was my first. This too shall pass, and you will learn from it. Give it time. Good luck!
  10. by   HouTx
    We have found that the best preparation for emergency response is 'hands on' simulation.... Although you can go over the procedures and see demos, the simulation drills are best. People need to actually handle the emergency equipment, locate those drugs in the crash cart & open those syringes, remove that headboard & put a backboard in place, wrestle with the ambu bag ... and practice recording. Whenever possible, we run the code drills as a multidisciplinary team & have found that a lot of our physicians are very supportive and enthusiastic about participating.

    OP may want to see if his/her department could begin to implement mock code drills. It pays off in the long run.
  11. by   "Just" a nurse
    I know what you mean, OP. I had my first code after just over a year as a nurse. Difference is, I work in a SNF, so we had to wait for the ambulance and run the code with just a couple of nurses and CNAs. The most horrible part for me were the compressions. By the end of the night (and this happened right at shift change), before I climbed into bed, I realized how very many things I had done wrong. But, there were many things that were done right, as well. Now I can honestly say that, should another code occur when I'm working, I probably won't get everything 100% right, but I'll get more right than I did the first time. Christy1019 and HouTx are right, (we) will get the hang of it; and experience, whether through real codes or simulations/mock codes, will be the best teachers. We all learn better, and remember more, by doing.

    Keep on keeping on - you're going to make it!
  12. by   NurseOnAMotorcycle
    Congrats for making it through! It gets easier. Just remember... you're never alone!

    Also, there's nothing scarier than your first code! Mine was in the middle of a 10 mile race on a bystander who wasn't even running! You'll never forget it. I agree about ACLS from the other posters. It helps you to practice these scenarios. Your hospital should offer it free to you.
  13. by   wellcoachRN
    The first code is always the hardest. You did amazing, especially since you haven't had ACLS. Please don't best yourself up over it. If you are interested, ACLS will give you the knowledge to feel more comfortable with any future codes. There are a ton of incredible resources online to help you. I would also inquire at your workplace if you are interested in taking ACLS.

    Wishing you incredible success I your nursing career!
  14. by   nurseprnRN
    Those plastic ties can be cut open easily with your scissors. You do have a pair of bandage scissors on you at all times, right? The longer ones are a lot more useful.

    Mueller Bandage Scissors