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My First Code

Specializes in Rehab and psych.

I am a new nurse I experienced my first code green (combative patient) yesterday. I was not one of the hands on people but it was emotionally draining for me. Is it normal to be left completely exhausted?

Definitely a normal reaction, especially if it is a new experience for you. I tend to get hyper alert and hyper focused but I think both are stress reactions. It's a stressful situation for everyone, don't let the fact that staff put on a calm face fool you. How are you doing now?

motor_mouth, MSN, RN

Specializes in Rehab and psych.

Doing okay. :) I actually found out that my coworkers went to bed super early last night also, so that made me feel better about how exhausted I was. It wasn't just me. It was all of us. My unit does not get a lot of codes and it was the first one for a lot of the staff. We were all on edge today, but nothing happened, thankfully.

Thanks for the input!

Mandychelle79, ASN, RN

Specializes in Psych.

I have a parasympathetic dump after codes. I actually take benadryl right after to help me not shake and puke.

Meriwhen, ASN, BSN, RN

Specializes in Psych ICU, addictions.

It can be unnerving...you're experiencing a completely normal reaction.

Do codes get easier? Well, over several years of experiencing them, I've managed to be able to stay calmer and less rattled during the code, but I can't always shake the heebie jeebies that may occur after the code. I may not appear stressed or rattled, but that doesn't mean I'm not, even if it's just a little bit.

motor_mouth, MSN, RN

Specializes in Rehab and psych.

Well, hopefully this won't be a normal occurrence on my unit. As I said, it was a very rare experience. I guess if it does happen again, I can expect the same reaction.

Luckily I was okay during the code, and for the rest of the shift, but literally when I walked out of the doors I felt exhausted, muscle ached, etc. Makes me glad I'm not on a unit where codes are more common, that's for sure!

TerpGal02, ASN

Specializes in Psych.

I've never worked anywhere that had a lot of codes but at my last job we did do a fair amount of hands on. We were a freestanding with no dedicated security. We didn't call a code (which would entail staff from the RTC program down the drive to come up) unless it was really ,really bad. 99% of our hands on was with the kids. They have no impulse control. If they want to hit you, they will. Rarely went hands on with adults and we had involuntaries.

The first hands on was nerve wracking for sure but it did get easier over time, although I am really not one that gets rattled easily. Do you have good code training under your belt? My old facility we had to retrain every 6 months and that gave me more confidence, I think. Where I work now people get tooanxious around possibly unpredictable patients. I think it's the lack of consistency in training and the fact that my unit is mostly older nurses who are used to the previously more docile patient population. We are a voluntary unit but recently have been taking more and more patients who probably blur the line between voluntary and involuntary. A lot are code calling happy lol. I think they are a little afraid of some of the patients which I am just not. Never have been. People at work think I'm a freak of nature because of how matter of fact I am.

motor_mouth, MSN, RN

Specializes in Rehab and psych.

TerpGal - I'm on a geriatric unit with the majority of patients having dementia so hands on is rare, and codes even rarer.

We did CPI non-violent intervention during orientation and then do monthly refreshers on the holds/escapes the facility wants us to use. Granted, I just started working there this month so it's all rather new to me.

I love my unit/coworkers. Everyone was very calm during the code, did what needed to be done, etc. It just exhausted all of us. Definitely not code happy on my unit given the population.

So glad to read others' stories/input about this. I feel like this is one area where psych really differs from your typical medical unit, which is definitely code calling happy when it comes to some behaviors that those of us in psych deal with every day.

Davey Do

Specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

Excellent inquiry after experiencing an emotionally-charged event, motor mouth!

Great responses!

Your Thread spurred quite a Discussion between a Peer and me last night at work. My Peer relayed his belief that such situations and subsequent feelings are Physiologically-Oriented and are the result of the Fight or Flight Adrenaline High and Comedown.

I, on the other hand, believe Sympathetic Emotions are more of the Root Cause. We often feel what the Patient must be feeling. Sympathy is less productive, often causing a superfluous expenditure of Emotion Energy. Empathy allows us to be Caring without the Emotional Exhaustion that typically follows a Personal Involvement in such situations.

Case in Point: At the age of 22, I was worked with the Emergency Corps as an EMT. I was the one to bring up the Drowning Victim and was quite shaken, for the Man was about my age. The other Corps Members were Respectfully Professional during the entire Operation. However, when the job was done, they all kidded and joked. I thought, "So this is how they deal with it! They do their job and when it's done, they kid around to relieve the stress".

Those Emergency Corps Members' Actions were an Example I emulate, to this day, 36 years later. Along with other Stress-Relieving Techniques, of course, like Processing, Art, Exercise, and the like.

In closing, motor mouth, I'd also like to let you know your Thread inspired a Cartoon. Although Absurd, its essence conveys the Discussion I had with my Peer about your Thread:

https://allnurses.com/psychiatric-nursing/jacob-rockstar-rn-979458-page4.html#post8425641

The very best to you all!

@Motor_Mouth First let me congratulate and welcome you to the behavioral health field. I want to commend you on seeking out the advice. I think that is a good sign and will do you well in the future.

I am not sure I can add much to the already good advice you have received from others here but I will. Codes seem to get easier, the more you have the more you become mentally and physically prepared for them. Your facility appears to offer a lot of training and that is GREAT and will come inhandy.

How fun is it that we got a comic strip out of this? LOL, so going along with my action figures persona(pretty spot on for me) I do have to advise you to be sure and find an appropriate outlet for your stress. I suggest a nice wooded area with lots of birds or a stream to listen to, tis the season.

@Davey Do, I continue to find it ironic that as a psych nurse the first thing I thought of with Motor_Mouth's exhaustion was a physiological response to a stressful situation and completely ignored the psychological/emotional trauma of the event on the body. I am sure both played a large role.

viperblue72

Specializes in Psychiatric, LTC, Palliative Care.

Having been a primary lead and responding member in countless codes/physical interventions, I can tell you the things that help me most are:

1. If time allows prep mentally for a few seconds beforehand-imagine scenarios and how they would play out ideally and what you can anticipate happening vs. what your response would be.

2. I think you mentioned using CPI-practice the moves!! Even if you don't have someone to practice with, walk through the palms up, arm around the waist, etc.

3. Take a minute afterwards, even if you don't have a debriefing policy, to talk to team members and also do some deep, focused breathing and focus on positive thoughts.

4. Humor-often at staff's expense in a safe, private environment (such as the med room) has always helped me deescalate myself following an event.

5. during the events you have to be mindful of your environment, breathing, and positioning. Not breathing calmly will just make things worse.

I cannot stress the importance of mentally prepping just before and physically walking through the motions enough. This is the primary thing (not the other 10 staff members in the room,) that saved me and another nurse from a razor blade. Don't ever feel weak for asking for a minute afterwards to decompress-it is best for YOU and also your patients.

MMC.RN

Specializes in Forensic Psychiatry.

I work in forensic psych in a state facility that primarily serves male patients and codes are a typical part of my day. I have to say that it does get easier with time and as you get more experience under your belt. I think the most important thing is to stay calm and take a deep breath, as much as you can anyway. It's always important to attempt to anticipate situations like this as much as possible and plan for each potential scenario. This means being vigilant at all times to potential violent and aggressive patients although sometimes patients tend to aggress with no warning. After the code is over I feel that it is important to debrief, make sure everyone is okay and let everyone calm down from the adrenaline rush that is inevitable. I find that my relationship with my coworkers is much different than any other facility I have worked as well. You literally have to have each other's backs and your safety is in their hands. We all have a very twisted sense of humor which I feel has developed due to the situations we've been put in. It's a completely unique field and it's difficult for people to understand who don't have that experience.

Good luck to you!

motor_mouth, MSN, RN

Specializes in Rehab and psych.

I hadn't checked back in a while.

There have been another code or two, and I responded to one on another unit, and no exhaustion followed. I guess I'm just more mentally prepared for it now that I know what happens.

As for practicing the moves, I practice the holds my facility uses, which is actually not the CPI moves. We use CPI for the non hands-on part of our training. It's rather strange.

And yes, we have debriefing after every code. I feel like a twisted sense of humor is a must in any medical field, and we've all got one where I work LOL.

Thanks again and maybe this post can help someone else out in the future!

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