Has ACLS been 'dumbed down'?

siggie13 · Dec 31, 2007

acls used to be an extremely rigorous course in the past. now, more and more people are getting it and it's practically a walk in the park. i understand the reasoning of it being viewed as a learning experience, but i'm wondering if the standards have become too lax? no one fails anymore.
what do you think, should the standards be tightened up again, or is it fine the way it is?

i feel the main purpose of acls is to acquaint everyone with their role in a code. i never understood why i, as the nurse, needed to know how to intubate, what drugs to give,etc. when i was not allowed to do any of this. nurses have a role and need to be tested on that role. in all of my codes, i have never been asked what drugs to give or to intubate. use it or lose it! so i learned facts for the test and then promptly forgot them from disuse. silly.

sleeplessonthelake · Dec 31, 2007

When I first took the ACLS, in 1983, we were taught to insert the central line. In my last ACLS course there was no practical of central line insertion.

getoverit, BSN, RN, EMT-P · Jan 1, 2008

When I took ACLS the first time 2 years ago, there were 10 OB nurses in a class of at least 80 people, all of whom were reviewing. So we were just thrown in to sink or swim, basically. Our facility bought exactly 4 books for our entire unit, so do the math there. Most of us had no access to books before class. The class was taught as if everybody was reviewing, everything was done in acronym-speak and when we would hold up our hands and say, "we don't know what that means, " we'd get "oh, you don't know what that means, EITHER?" as if we were complete morons. I venture to say we could have devise a lecture of OB-Speak that would have baffled them also. So that was the tone from the get-go.
We did have mega-code which were just us, with the instructor. I preferred that to the the group mega-code at the most recent one I took. In this scenario, everybody has to perform independently, but with everybody else looking, either sympathizing with you or thinking how pathetic you are.
Both were stressful, very stressful, and any of you who get cold sores will relate to that, I'm sure.
AS far as choosing "not to participate" as someone said, of course, we all participate. We've all had Basic CPR and ours is not available online or in 3 minutes. I feel that since there is a code team, my best contribution would be to get that oxygen going, have the patient lying flat, get the crash cart in there, begin chest compressions, and then let them come in and do what they know best: meds and all the rest of it.
Under no circumstances am I qualified to lead a code and for them to put me in that capacity is unfair to everyone concerned. And thus, I don't think the mega-code situation, either time, was of any use to me at all. I honestly remember very little of what or when or if or how much. It was justs simply too over-whelming for me.
But put me in an obstetrical emergency, and I'm there! And knowing how fast ER people hand off any female who's EVER missed a period to us, I think they understand that. And you EMT's out there, try using veins in the hand or wrist for OB patients who call you with nothing but "i'm contracting" complaints. They are horrible for patients who will need to move and hold babies. We don't even use the antecubes for our bleeders. If we can find other veins, so can you. Fastest access isn't always best.
We are all good in our own chosen areas. I respect that and also respect that those not used to OB situations are uncomfortable. Please give that respect back to those of us who are not used to the other. We are willing to help as best we can, but expecting us to have expertise equivalent to what those of you who do this every day, is unfair.

I'm sorry you and your co-workers had this experience. It is definitely not the way it should be. You bring up many good points about differing specialties and practices. My mom was an OB nurse, her dad was a cardiologist. Every time he'd walk through her ward she'd ask him to have a cup of coffee and he'd always say "No way! You guys might ask me to do something!!" They'd laugh but it is a way of showing respect and understanding when you're out of your element. The megacode should be performed in the classroom as close as possible to the way it is conducted in an actual situation. to sit and perform while everyone else watches is pointless. The purpose is to refine a teamwork approach to a cardiac arrest and make everyone familiar with a similar language. why would anyone waste time memorizing all the myriad drugs and algorithims when they can be referred to. We allow our students to refer to any AHA cards or "cheat notes" that they would normally carry during their shift. Knowing how to reference something is sometimes more important.

And I don't know how anyone recertifies online. Is this an AHA-endorsed recert? My understanding was that NO AHA course could be recertified without being physically present in the classroom.

sharona97, BSN, RN · Jan 1, 2008

I performed my mega-code by myself in a room with an M.D. and one of the instructors.

This is really beginning to sound as if it is not practiiced the same.

pebbles, BSN, RN · Jan 1, 2008

I performed my mega-code by myself in a room with an M.D. and one of the instructors.
This is really beginning to sound as if it is not practiiced the same.

I did too, and only a couple of years ago.

Where I live, we have nurses that are alone in really rural hospitals that don't have a doctor overnight. So if something comes in, you ARE the "code team". So that is why I always appreciated learning all roles.

It also helps to have the perspective of the whole "team", and not just what your own job will be. Especially for the training scenarios, when you are separate from "real" life and death situations.

getoverit, BSN, RN, EMT-P · Jan 3, 2008

I am scheduled to take the one-day ACLS recert class in a couple of weeks but wonder if I should retake the entire 2-day course. Don't use the material in my job, but I do understand it. In your opinion, does the one day recert class pare down the info too much to successfully complete the course? Thanks...

Hey. Sorry it took a few days to reply. The one day recert should be fine for you if you feel like you understand the material. It does "pare things down" in a way, but another way of looking at it is "filtering out what you don't need". I don't know what setting you work in, but for example: unless you hang Integrillin/Reopro/Aggrastat, etc on a regular basis, then knowing their class and general actions is all you really need.

ACLS can make you think until your nose bleeds, but there's no point in making it that hard! and like I had mentioned in another post, knowing how to reference the material is as important as knowing it straight off the cuff. You sound like you feel comfortable with it and I'm sure you'll do fine. Just take a few hours before the course to refresh your memory, look over the algorithms and identify anything you feel you need clarification about so you can ask specific questions once you get to the class.

Hope this helps somewhat. let me know how it goes!

DutchgirlRN, ASN, RN · Jan 3, 2008

ACLS used to be an extremely rigorous course in the past. Now, more and more people are getting it and it's practically a walk in the park. I understand the reasoning of it being viewed as a learning experience, but I'm wondering if the standards have become too lax? No one fails anymore.
What do you think, should the standards be tightened up again, or is it fine the way it is?

Why make it harder than it has to be? The objective is to have a basic knowledge of what to do during a code. The majority of nurses who take ACLS are not allowed to give the meds independently but when ordered to give a med they know why as well as how. I say the simpler the better and the more who can take it and pass, the better.

BTW each time I go for renewal there are nurses who do not pass.

featherzRN, MSN · Jan 11, 2008

I just did ACLS recert today and it is WAY easier than it used to be.

My first one I took in the late 80's and we had about half the class drop out and several failures. You had to run your megacode with no help and you COULD fail and you had to go through a zillion rhythms and even read a 12-lead. I remember study groups and flashcards!

For this recert, I didn't even have the latest book, nor did I study. I just went to the one day class, listened to the instructor, watched the movies, passed the test (100%, 25 questions with a few simple rhythms - VT,VFIB, Asystole) and our mega code was done in a large group with everyone yelling out the proper steps. Oh, and they didn't make us intubate like we did in the 80's, nor did we have to worry about central line placements.

And this is coming from someone who works outpatient in a clinic that doesn't even HAVE a crash cart . Would I be able to run a code? probably not, but I might be a better team member if I need to be.

sharona97, BSN, RN · Jan 11, 2008

I just did ACLS recert today and it is WAY easier than it used to be.
My first one I took in the late 80's and we had about half the class drop out and several failures. You had to run your megacode with no help and you COULD fail and you had to go through a zillion rhythms and even read a 12-lead. I remember study groups and flashcards!
For this recert, I didn't even have the latest book, nor did I study. I just went to the one day class, listened to the instructor, watched the movies, passed the test (100%, 25 questions with a few simple rhythms - VT,VFIB, Asystole) and our mega code was done in a large group with everyone yelling out the proper steps. Oh, and they didn't make us intubate like we did in the 80's, nor did we have to worry about central line placements.
And this is coming from someone who works outpatient in a clinic that doesn't even HAVE a crash cart . Would I be able to run a code? probably not, but I might be a better team member if I need to be.

Scary no crash cart. Ask for one.

DutchgirlRN, ASN, RN · Jan 11, 2008

And this is coming from someone who works outpatient in a clinic that doesn't even HAVE a crash cart

I work in an outpatient imaging center and we do have a crash cart. I have to stay current on ACLS and I frequently review, esp the meds. I am the only nurse in the building so if we have a code it all falls to me. :icon_roll

sharona97, BSN, RN · Jan 11, 2008

Please OP reread post #45. You mentioned you did not have a crash cart while w:idea:orking in an outpatient clinic. I don't think anyone posting here is questioning your skills, we wanted you to have a crash cart! We are supporting your post.

featherzRN, MSN · Jan 11, 2008

I'm not the OP, maybe I wasn't clear.. ? As for us not having crash carts, they were removed from all outpatient clinics last year. We have an AED only and call 911 for anything past that. Still, acls is good to know!