Has anyone coded a co-worker? Dealing with the grief...

[Zookeeper3]

The worst happened, a co-worker arrested at work, taken to the ER, then sent to our ICU. As you might imagine, it was a challenge, as no existing IV or attending doc, the pure shock of treating one of your own... the staff that came from everywhere, and the tough task of reigning it all in.

Has anyone else been through this?

Even though we care greatly for each patient, the element of having to code one of our own, presented much more stress, chaos for the code situation and emotions increased in an unknown situation of lack of medical history.

Although everyone did the best care they could in this tough situation, I'm left pondering how we could have improved, I suggested a post code conference for all involved. However as can be imagined, staff was emotionally exhausted, two hours behind on their patient care and even though it was meant to happen and planned it didn't due to the acuity of multiple admissions and possible avoidance of the situation.

Things did not go smoothly (although best care was attempted) and there are always areas we can improve our practice, and the area the staff member coded was not one that does this routinely. So even if it was an inhouse patient, there are areas to discuss to enhance future care.

So now I don't work for several days, I had attempted for this to be a teachable moment and possibly change some practices, but I am a traveler, and this is a tight knit group that seems to be shutting out my suggestions, while I only want everyone to benefit from hind sight and improve on practices... but as this is not my home, and I am a "stranger", I feel I am not being listened to.... as everyone is obviously in shock and grieving and not seeing the benefit of a post code gathering.

Suggestions? Does gently pushing a request for a group discussion interfer with the existing dynamic and I should let everyone deal on their own, and my suggestions for improvement are inappropriate for the situation?

I just need to know how to support a new work family and not ever, ever make it seem that I find any fault, only a few suggestions but we need a better plan as this could happen to a visitor or staff and i really wish the best outcomes that we can provide.

Feedback is appreciated. Thank you

[nurse2033, MSN, RN]

I disagree that as a traveler you are second class citizen. For everyone who thinks that, is that the way you treat travelers in your unit?

I would go to the manager of the unit to voice your concerns and suggestions. They know their people best and how to approach them. I applaud you efforts to help them deal with it.

[Esme12, ASN, BSN, RN]

Yes I have....unfortunately.

They were all traumatic for all involved. One was a supervisor that was a brittle diabetic and he was as regular like clock work. One night we hadn't seen him as usual and started looking for him. We found him in a stairwell, unconscious for an unknown period of time. It was actually an extended period of time, went into V.Fib arrest. He died a few days later.

Another was the hospitalist who went missing. I found her apneic....with a faint pulse.....after a significant cluster getting help, no one could "find the sleep room. Couldn't get the operator to answer the outside line to call a code (no phone in the room I had to use my cell......and the list goes on.......she survived.

Another was a beloved co-worker who committed suicide and came in with a GSW.

It is very hard on staff when this stuff occurs and they may feel you are stepping out of bounds as this was "their" friend. They are going to draw inside their "group"and view you as an outsider right now....although that is not how you feel. I agree that a debriefing is in order. Most facilities have code teams that quality look at each code and critique the procedures. Some even have a critique section on the resuscitation sheet itself.

Most debrief/grief counseling I would have a couple of weeks later when the emotions are not so high. Sometime i would have them off site so they feel more freedom to express their feelings and frustrations.

Be there for them. Listen actively and passively.Offer them caring and support.I am sure they know how the code went and right now they are struggling with their feelings.....right now they need a friend to care.

:hug: To you and the staff, my prayers for healing and peace. You are a good friend/co-worker to have around.

[RENU845]

Wow, this conversation really suprises me. I am reading this not as a nurse, but as another healthcare professional. I felt compelled to leave a comment. With a few exceptions, the comments seemed to endorse the idea that the traveler nurse had less rights than the house nurses. I would hope that any ideas for process change, especially when the process is a CODE situation, would be welcomed and treated with respect. I have nurse friends who speak of the division between the two nursing groups, and obviously that division is alive and well, and most on this thread are ok with that...WOW.

[beckster_01, BSN, RN]

I don't think they are saying the traveler has fewer rights, they are saying that the in-house nurses may revert to viewing Zookeeper as an outsider in an emotionally traumatic situation.

It doesn't mean s(he) has any less of a right to be upset about the experience. It just means that the other nurses are probably less likely to take suggestions from a traveling nurse on how to cope with it. This totally depends on the work environment and what the relationships are like.

[Zookeeper3]

Exactly beckster... this was my concern. Thank you everyone for "listening" to my concerns and keeping me on the right track. For all concerned about me being a "traveler", thank you so much. I don't feel that my suggestions would be less relevant to the hospital, I want to ensure that my suggestions will be at the right time, place and I love the people I work with. They did the best they could. Thanks for having my back fellow nurses :)

That being said, I have different experiences, that could improve the process, but because this is so new to everyone, me included and so raw to them, I appreciate any advise as how to proceed.

I do not take any objection from those saying "stay back", you are a traveler, it is advice and that is what I am looking for.

Thank you everyone for the thoughts and advice... I'm taking a deep breath, will continue to read your advice and consider approaching the manager, once I can get my thoughts together and be sure I can suggest change, that isn't viewed as finding fault. A very difficult task for a "stranger".

[PennyWise]

Thats the politics of being a travel nurse. You are a part of the team, but you are not one of the team.........if that makes sense. It's kind of like being the kicker or punter for an NFL team. Many of your team mates will say "You're not a real football player"...........then turn around and rely on you to win the game (or be critical of you if you don't).

For many units that use travel nurses, there are a lot of unwritten rules about how they should act and how they are utilized. Often you get the worst patients and/or the most patients, you could work every holiday and, with regards to the schedule.........you work where there are needs. If you don't moan about these things, they'll love you (as an outsider) and you'll be renewed every time. The second you start demanding equal treatment.........they'll inform you you are not being renewed for w/e reason ("Oh, we are trying to cut back on traveler utilization.").

And as far as making suggestions about how the unit should go about making policies or handling any situation..............FORGET ABOUT IT. They simply are not interested. It's just that way. Again, you are a bit of an outsider and any suggestions you make about how things could be done better will be met with teeth clicking and dirty looks.

The reason for this is simple: To open the door to travel nurses to have a say in how improvements could be made would open the door to one of the suggested improvements being............more fair assignment making for travelers, or more consistent schedules (etc etc.....) and they would sooner swallow glass than hear any of that.

Many travel nurses actually consider this (not really being on the team) one of the advantages of their position. You don't go to staff meetings (I didn't anyway), people don't bring the office politics/gossip to you and no matter how bad things are you have the option of being done with the place in the next few weeks if you like.

[hiddencatRN, BSN, RN]

It sounds like a critical incident debriefing to deal with the emotions involved would be more appropriate at this time than a look at everything that went wrong. It's so hard to do everything right when it's one of your own. One of the units at my hospital had to code a coworker once and they were all so shaken they were fumbling and running in to each other apparently. What helped was staff from other units arriving to continue the code. Staff that wasn't as close to the patient.This happened before I was working at my hospital but the event was so traumatic that it's come up in other critical incident debriefings as an example that when it's your people who are in trouble, it's hard to function well.

[nerdtonurse?, BSN, RN]

We all grieve different ways, and we've all seen families blame themselves when something happens -- "If I'd just called Ruth to see how she felt..." or "He said he had a headache, I didn't think it was a stroke..." and it rapidly progress to "You NEVER called Ruth, and now see what's happened!" Some people react to grief by offloading -- loudly -- on someone else. I'd suggest being a listening supportive presence; these people are going to have to grieve, and I'd hope the house chaplains or maybe hospice resources are being utilized.

I helped on another unit when one of the nurse's child was going down the tubes -- I was starting IVs and trying all I could do to prevent a code, but the "ice wall" was up in full force, it was the nurses being protective of the parent who'd thought the child was just trying to get out of school when it was meningitis. Had I suggested an inservice on recognizing bacterial meningitis (which would be a good idea) or "When the patient's a family member" they'd have eaten me up -- not that they didn't like me, or it was a "ICU vs. floor" situation, they just closed ranks as a protective measure for the coworker and even as an employee, I was not one of "us" I was one of "them."

Wonderful idea. But in this case, I'd let it go.

[Simply Complicated]

I don't personally think it's an issue of being an "outsider" due to being a traveler, or not being "one of them". It's more about who has history with the person, and who had closer relationships with the person. As a traveler, that simply means you have not been there long enough to become as emotionally attached to the person, so while upsetting to you, it probably wasn't quite as emotionally traumatizing as it could have been for other people. So while they were forced to act in a professional capacity while running the code, after the fact, they are able to react as a friend. So running through what could have been differently, and trying to view the situation from a professional standpoint again is just NOT the frame of mind they are probably in regarding the situation. Someone with more distance will find it easier to view it from that professional standpoint, that they may just not be capable of reaching right now.

[OCNRN63, RN]

I disagree that as a traveler you are second class citizen. For everyone who thinks that, is that the way you treat travelers in your unit? I would go to the manager of the unit to voice your concerns and suggestions. They know their people best and how to approach them. I applaud you efforts to help them deal with it.

No one said she was a second class citizen. Most simply expressed that she should probably let the NM or someone else from the established staff take the lead in organizing any support/debriefing session.

[NicuGal, MSN, RN]

We had to code one of our co-workers and I can tell you things could have been done different, but it is so emotional when it is someone you work with and are good friends with. Personally, if someone told us, well you should have done ABC, we would have eaten you alive. We needed emotional support, esp since that co-worker died in our midst. A debriefing was done, but it wasn't what we did wrong and what we should have done, it was for our emotional well being. Once the code team got there, we left it to them, and we were more than happy to do that.

[OCNRN63, RN]

I agree. I think the last thing this staff needs to hear is what they could have done better. A supportive meeting where they can talk about their feelings would be more appropriate, but if they don't want that it's their decision.