do any of you like codes??

postmortem_cowboy · Feb 17, 2007

Even if codes are so amazingly otherworldly...they are not something I look forward to doing, EVER!
Perhaps, because I just have trouble thinking well on my toes while everyone else is scurrying. It's just plain not fun!
And why is it that they always come in twos or threes???
Additionally, I find the code process tiring, not exhilerating at all!!! In fact after suffering over two codes in a night, I'll be found crumpled off in a corner of the Tele floor whimpering like a pet mongoose.
PS...I know, I know! I should work more with my ACLS flash cards, but I think I'd rather be enjoying my dogs, daughter, and laughter on my days off!

There's nothing wrong with not liking them. Alot of people don't care for them. I don't know how many times i've been told in an excited state that I need to quit enjoying it so much. I've worked with alot of nurses that detest all the paperwork that goes with them. It's all preference. Some people enjoy them, some don't, some are comfortable with them, some aren't. Doesn't mean your less of a nurse if you don't care for them. There's things in nursing I don't care for that others may take great pride in doing. Hey i'm so nosey, if a code waltzes through when i'm in doing something else, even if it's half over i'll go and poke my nose in when i'm done and help out.

Wayne.

leesespieces · Feb 17, 2007

I love codes too. I will be a new grad in May and I am really hoping to land a job in ICU or ER.... It does sound sick and you almost hate to admit it, but it's exciting!!!

postmortem_cowboy · Feb 17, 2007

Well there's a difference between wanting someone to code or die for lack of a better term, just so you can run a code, rather than you want something exciting to happen and when it does, you enjoy performing your job. Sick would be wanting a code to happen and then not doing anything about it. Besides that, a shift goes alot quicker when your busy and have things going on. I remember one code that came in a couple of hours before my 3-3 shift was to be over. By the time we'd gotten the person worked up, called, the police came and searched her belongings, family members were contacted and said their good-byes, the next time I looked at my watch I was like 15 minutes late from clocking out and going home. I hate those shifts where time stands still, and you can hear the "clunk clunk" of the second hand ticking by. I'd much rather it be busy, have more than my share to do and get done, makes the shift fly by.

Wayne.

leesespieces · Feb 17, 2007

I agree. I would never want a code to happen so someone could die. And I would most definetely NOT stand there and do nothing!! As it is, having been a part of a code as a CNA and nursing student, I am not allowed to do much at all and I can't wait for the day I get to be right there pushing the meds, bagging, doing compressions, assisting with intubating. I can't stand being bored either!!! Time goes but so slowly and I know I bug the crap out of my patients when there's nothing to do, I am constantly checking on them when I'm sure they'd rather be left alone to get the rest that is so hard to come by when you're in the hospital!!!

postmortem_cowboy · Feb 17, 2007

I agree. I would never want a code to happen so someone could die. And I would most definetely NOT stand there and do nothing!! As it is, having been a part of a code as a CNA and nursing student, I am not allowed to do much at all and I can't wait for the day I get to be right there pushing the meds, bagging, doing compressions, assisting with intubating. I can't stand being bored either!!! Time goes but so slowly and I know I bug the crap out of my patients when there's nothing to do, I am constantly checking on them when I'm sure they'd rather be left alone to get the rest that is so hard to come by when you're in the hospital!!!

You'll get your chance, trust me... you'll get your chance. In the hospital I work for nurses usually only do certain things during codes. Respiratory usually comes in 3 deep to do all the chest compressions, doc presides and tubes if necessary, nurses run the monitors and IV fluids and push meds. In california, although we're taught to intubate, we're not allowed, that's the doctors decision, however we're taught in ACLS how to do it. I'm an LVN and can tube, but haven't ever been allowed to, even on a code up on the floor when the docs 5 minutes away from arriving on scene and i'm the only ACLS nurse for the whole floor. Pretty pitiful that i'm surrounded by M/S RN's that aren't ACLS qualified and here I am a measly LVN and I've got the certification to do things they aren't certified to do, but can't do them because of my licensing.

Personally, and this is just my own opinion, if your qualified to know what this drug does and what that drug does, and when to give this or that drug, it should be a part of your scope with an expansion, IE LVN's pushing only ACLS meds when they are the only ACLS certified nurse available. If a code starts, and no RN's are around, and it's just one LVN that's ACLS certed, how long do we wait to give epi and start working this patient up before someone can get there on scene who can? Is that in the best interest of the patient? ACLS for LVN's needs to incorporate this in my opinion, the board needs to realize that if we are taking that certification on, we're accepting the responsibility of a coding patients care and allow us to perform what it is we know how to do. This area is specialized and should be available to us but it isn't. I think that's one thing of many that is wrong with Health Care.

Wayne.

Dinith88 · Feb 25, 2007

I noticed you're a student nurse. This is normal. After awhile in nursing...when you've done it a gazillion times, you'll get less a 'rush' from it....but it wont totally go away.

Actually any nurse who's participated in tons of codes will tell you a code-blue is actually 'easy'...especially when there are 9 million eager-beavers all wanting to get in on it (usually the case in any hospital). 99% of the time, codes are 'automatic' and involve a routine (ideally based on acls algorhythms)...and are more 'reaction' than actual 'thinking'...(abc's...etc.).

You'll eventually find yourself in codes that you're ticked are even taking place... (99yr old granpa, late-stage cancers, alzheimers, etc.).

I work in ICU so i see (any icu nurse will attest to this) lots of 'successful' codes (meaning a heart rate/bp was restored) that mean nothing because the person was down for too long...with severe anoxic brain injury/death...and 1-2 weeks later ends up trached, pegged, and in a nursing home in a persistent vegitative state)...

The 'good'(fun) codes are really awesome to participate in...(especially if you're doing it before doctors can get in on it :) )..The best example of this is when a code is called, you run to floor, 5 floor nurses are freaked-out, patient down, chaos all around...patient in v-tach/fib...and you defibrilate...bring the patient back magically with the push of a button (or more dramatically with paddles)...patient wakes up before being tubed...doctor runs in and is deflated a bit... you pump your chest...floor nurses look at you dreamily as you kiss your biceps...you've not broken a sweat... ahhh... Is this why you get so pumped about codes? Shoot...it's what most male-nurses secretly dream about.. :)

edited to add disclaimer: I never 'want' a code to happen...ever... for ethical-reasons (and to 'desire' one is, i think, borderline amoral. Adrenalin is one thing, wanting someone to die for it is ummm... but i'm sure OP means he likes adrenalin). Also, like i said, participating in codes is easy...it's keeping them from coding that's the hard part.

Dinith88 · Feb 25, 2007

You'll get your chance, trust me... you'll get your chance. In the hospital I work for nurses usually only do certain things during codes. Respiratory usually comes in 3 deep to do all the chest compressions, doc presides and tubes if necessary, nurses run the monitors and IV fluids and push meds. In california, although we're taught to intubate, we're not allowed, that's the doctors decision, however we're taught in ACLS how to do it. I'm an LVN and can tube, but haven't ever been allowed to, even on a code up on the floor when the docs 5 minutes away from arriving on scene and i'm the only ACLS nurse for the whole floor. Pretty pitiful that i'm surrounded by M/S RN's that aren't ACLS qualified and here I am a measly LVN and I've got the certification to do things they aren't certified to do, but can't do them because of my licensing.
Personally, and this is just my own opinion, if your qualified to know what this drug does and what that drug does, and when to give this or that drug, it should be a part of your scope with an expansion, IE LVN's pushing only ACLS meds when they are the only ACLS certified nurse available. If a code starts, and no RN's are around, and it's just one LVN that's ACLS certed, how long do we wait to give epi and start working this patient up before someone can get there on scene who can? Is that in the best interest of the patient? ACLS for LVN's needs to incorporate this in my opinion, the board needs to realize that if we are taking that certification on, we're accepting the responsibility of a coding patients care and allow us to perform what it is we know how to do. This area is specialized and should be available to us but it isn't. I think that's one thing of many that is wrong with Health Care.
Wayne.

Wayne i agree. Whats the point in even being acls 'certified' if you cant do it?

Just so you're very 'aware' of what you should do but cant???

... thats VERY dumb... Is this just california?

Shamira Aizza · Feb 27, 2007

In a former life when I was a paramedic, I enjoyed the application of skills involved in working a 'code,' starting from scratch, and delivering a patient to the ED with an Endo tube, 2-3 IV's, a respectable introduction of ACLS drugs, chest decompression for trauma patients, and not so uncommonly...a resuscitation, all neatly packaged on a spine board.

I was disturbed when I saw colleagues bringing in arrests that were half-secured on the board, head flopping around with no cervical immobilizer, not intubated because "we just couldn't get the tube in," or improperly intubated, one IV, and only a couple rounds of drugs on board. I'd also get steamed when I'd back up a crew on a code and find them attempting to intubate, and the defib/monitor hadn't even been attached or turned on yet.

A prehospital code was one opportunity to instill confidence in your colleagues because it was the worst situation to encounter (for the patient), and we couldn't make it worse. It was a great chance to bring everyone together to do a lot of stuff in a short amount of time, and to take pains to do it well. I would often take a full 20-30 minutes to work a medical code on scene to make sure I addressed all the differentials and that no intervention (including CPR) was compromised to move the patient...because I found that we were doing all the most important stuff earlier without stressing about the move to the ambulance, and if we cut corners on interventions to get them down the stairs (few people code on the first floor), we were simply delivering them to the hospital sooner so they could be "called" sooner for termination. I figured if it was generally going to end up that way, then there was no need for us to be in a big hurry to transport them to the hospital where they were going to get more of the same of what I was doing.

I also thought codes were great opportunities for new paramedics to get some solid experience in patient management for less-frequent skills, i.e. intubation and PROPER endo tube securing, and I made every paramedic student establish an external jugular on code patients for second IV access.

We also would not redball to the hospital, because I hated getting tossed around in the back, and no evidence shows that the 60 seconds made any difference...they just got called 60 seconds sooner. I think I have about 30 rescusitations, with about 12 surviving to discharge. Those were my favorite.

Now that I'm in the hospital, and in a pediatric ICU, I hate codes. It almost always involves an open chest (and obviously a child)...and I prefer to call a rapid response team or a physician for some strong medicine before we get to codeville.

jbtampa · Mar 21, 2007

RRT/RN student here....In Florida all RTs are intubating at least in class and often in most hospitals. We all pass muster in class and frequently are the first to arrive at a code and in goes the tube. Still, I don't like it. just my .02

robred · Apr 13, 2007

I once worked with a very good nurse: technically competent and had an empathic, compassionate way about her. She also would occasionally say that she wanted a code 'for a little excitement' or to 'get her adrenaline going', etc. One day shortly after she said this, we were called down to our small town ED from ICU to help manage a murder-suicide; a man shot his wife and then called 911, told them he had killed her and then shot himself. They were both coded and died. Afterwards, I couldn't help but approach her and say, "Be careful what you wish for". She never made those statements again.

clc19k30 · Apr 17, 2007

I have a love hate relation with Codes. I think of them as soft or hard. A Soft Code starts with the change in the rhythm on the EKG. So you have time to get the Docs and everyone alerted.

The hard code is when the ambulance pulls up or the chopper sets down and chest compressions are going on. You just go into lifesaving mode even though you know that if the chest is being pushed you are already behind the eight ball and failing fast.

I think that now as I look back on all of the Codes, the softs and hards, that it hurts the most with the hards. They are usually young people who have met a violent event.

CRNI-ICU20 · Apr 17, 2007

robred: i second the motion! i read and re-read the author of this thread's words.....and it kind of bothered me...

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have a confession...i like codes, ok, i love codes.

i don't like that i like them, because, i know it means a human being is in big trouble. but my heart gets pumping, pin point pupils, adrenaline racing, my entire being focuses intesely on the moment....just thinking about it gets me excited. (this is disturbing to me, because it reminds me of what an addict will say about their love of a drug...)

even when they are over, the after glow keeps me going for hours. sometimes when the floor gets slow, i "almost" want a code. (afterglow??? an afterglow implies that there was some sort of "fix" or high achieved.)

my moral compass tells me this is wrong. i should not "want" a human to code. but i know they will, and the hospital is the safest place on earth for it to happen, and i want to be there when it happens. (when did a code evolve into something about the nurse?? isn't the code about the patient and their fight to live? and our assistance with that?)

does any body else feel this way??

i should also point out....i get very anxious and nervous when pt's expire. and aftercare makes me shake for about a day or two. i don't like death.

(expiration means no longer able to provide a "fix"....you can't code a dead person... why would aftercare of a patient who has died cause such anxiety and nervousness?) any meaningful comment would be appreciated.

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without sounding harsh, ryan, have you ever explored where these intense feelings are coming from?

i know alot of us here have expressed how, in the heat of the moment, we like the teamwork, the intense rush of saving a dying patient, and then helping them hopefully survive the event....but i have to say, being adrenalinized by the actual code, and "almost wishing one would happen" are really not on the same page.

i think this kind of thinking is detachment at best....because it's about fulfilling a need inside of you, not about the pain and anguish of the patient or family at a crisis moment....

i am glad you are honest about these feelings, and that you have shared them here. wanting to be part of a top notch code team is one thing.....but wanting/wishing for something bad to happen so that you can feel the rush of adrenaline, pinpoint pupils, heart racing, etc. is a bit out there for me....

maybe it is because i have been a nurse at the bedside for over 20 years and have participated in some horrific codes....open chest massage, young father bleeding to death in front of his wife and kids, and we couldn't save him...(just one comes to mind)....i can tell you, i feel/felt no adrenaline, nor did i get a rush from coding this patient....

i would encourage you to examine where these feelings are coming from....if you are feeling a disturbance in your moral compass about this...there just might be a reason....

you seem to be a sincere and honest person....but again, like robred said, we have to be careful what we wish for, and why we are wishing for that to happen...

a code is never about the nurse....ever.