Nurse Manager and Charge Nurse Roles During a Code

elizabells, BSN, RN · Dec 1, 2007

I work nights, so I've never seen our NM during a code. Not sure what he would do, frankly.

Our charge nurses usually come, as a code alarm rings to all the phones the docs, RTs, and CN carry. They usually stay in the background, make sure stuff is being recorded for later charting, draw up/pass meds to the folks at the bedside, and act as a resource person. It's good to have a "cool head" person who's not directly involved in the action. Once in a while they don't come if they're relieving someone somewhere that they can't leave, like the person on the L&D floors for deliveries.

I have a feeling that every answer you get will be different, reflecting the different P&Ps that every unit has.

EmmaG, RN · Dec 1, 2007

Your hospital should have a policy that defines each staff person's role in a code.

EmmaG, RN · Dec 1, 2007

I work nights, so I've never seen our NM during a code. Not sure what he would do, frankly.
Our charge nurses usually come, as a code alarm rings to all the phones the docs, RTs, and CN carry. They usually stay in the background, make sure stuff is being recorded for later charting, draw up/pass meds to the folks at the bedside, and act as a resource person. It's good to have a "cool head" person who's not directly involved in the action.

When I was night charge, that was pretty much my role, to 'oversee' the code. I'd make sure that there was staff remaining to monitor other patients, and someone posted outside the room as a 'runner' to get whatever was needed in the code.

Ours were pretty calm and methodical. We all worked really well together as a team. After traveling and watching codes in other facilities (particularly larger, teaching hospitals), I think something that made a big difference was how well we all knew each other--- floor staff, code team, hospitalists, supervisors--- most of us had worked together for years, and I think that made things run much smoother.

And the Chief hospitalist had put together an amazing group of docs who really knew their stuff. We knew we could trust him and his group to respond immediately to any concerns we had about a patient. They knew and trusted us too, so if I had someone who just didn't 'look right', these docs were right there to evaluate the situation.

We didn't have a rapid response team when I worked there, but many a code was averted by the actions taken by our hospitalists.

Tweety, BSN, RN · Dec 1, 2007

I'm a charge nurse and my defined role, as written in policy, is to cover the patients that are not covered by the nurse(s) in the code, call the MDs and inform them of the code and get orders, call the family, call the chaplin if needed, arrange for a critical care bed if the patient survives, etc. and kind of act like an air traffic controller, but not actually be in the code.

This is problematic because judgemental staff will say "humph, did you see him during the code? I didn't. He didn't do nothing..humph", not even knowing I usually run my butt off. But the roles are clearly defined, the nurse whose patient it is does the recording and reports to the code team the patient's condition, an ICU nurse shows up to pass meds, the resident MD shows up to run the code, etc. etc.

Most of the time I'm right in the thick of things.

Our Nurse Manager has no role during the code, because as you state they might not be on the floor, so it doesn't make sense to expect any role there.

Trauma Columnist · Dec 1, 2007

From a different perspective: in the ER setting, the charge nurse usually stays out of things and conts to coordinate care and pt flow thru the system. There are usually two RNs, an RT, a resident MD, an attending MD, chaplain and a tech to do CPR and that's it. However, it would not be unusual to have two codes at the same time in a busy ER.

Like someone else said, its going to be variable depending on the setting.

UM Review RN, ASN, RN · Dec 1, 2007

Our Charge Nurse is expected to report the need for a Code to the Administrator on duty. The AOD comes to the room as soon as possible and coordinates the patient's move to ICU.

Meanwhile, the Charge nurse generally coordinates flow of traffic in and out of the room and will help wherever she can. The patient's nurse will call the doc and report the change in condition. Often the Charge nurse will stand by the patient's nurse as she talks to the doc. The Charge Nurse can then collect the meds and equipment for stat orders so the patient's nurse can start charting all the events in the patient's chart.

I'm pretty sure that any nurse can record; I've occasionally had the record sheet shoved into my hands on entering a room.

Anyone with CPR can do compressions, and in an extended Code, everyone takes a turn.

The NM doesn't really have any direct role. All incidents like Codes will ultimately get reported to her, because anything that gets sent to Risk Management (and a Code is one type of incident) will also get sent to the Nurse Manager.

MzMouse · Dec 1, 2007

I work in a clinic, so we don't have a lot of codes. The coordinator/NM role during a code here is to stay with the family and keep them informed.

flightnurse2b, LPN · Dec 1, 2007

i used to work nights, so the nurse manager wasn't there alot. but we had 2 chg nurses in the ER so if there was a code, one would come in the room with us and do whatever needed to be done (compressions, meds, recording, whatever)... and one would facilitate the tx to icu, notify family, etc. we never had "specific" roles so to speak. whoever grabs the defibrillator first is in charge of that, whoever gets the ambu bag first is in charge of that, etc etc and we all would just pitch in wherever need be with an IV or a turn at compressions.

clee1 · Dec 2, 2007

i used to work nights, so the nurse manager wasn't there alot. but we had 2 chg nurses in the ER so if there was a code, one would come in the room with us and do whatever needed to be done (compressions, meds, recording, whatever)... and one would facilitate the tx to icu, notify family, etc. we never had "specific" roles so to speak. whoever grabs the defibrillator first is in charge of that, whoever gets the ambu bag first is in charge of that, etc etc and we all would just pitch in wherever need be with an IV or a turn at compressions.

This is generally what we do too. It works surprisingly well.

nursej22, MSN, RN · Dec 2, 2007

I am on a cardiac/telemetry floor. Every code is different, but generally the charge nurse is directing the rest of the floor, directing traffic, making sure the family is notified and speaking to them and pastoral care, supporting the nurse whose patient is coding--many of our staff are new grads. Our hospital P&P assigns roles to the various responders ER RN, ICU RN, security, etc. Who ever is there first starts, then the assigned person will take over as they arrive. The house manager will assign jobs prn, get an ICU bed, dismiss people as they are not needed ( you can never find an RT to give an HHN, but call a code and 10 of them appear ready to intubate!). I don't think our manager has a role, but I can believe that she would attend to the family prn.

TRAMA1RN · Dec 2, 2007

I have only done ER from very small community where I as the only night ER RN and ER doc whom I would awaken for codes would run the codes with nursing supervisor coming to help and x-ray tech to assist as well. Larger hospital more RN's and usually 3 RN's and ER MD and sometimes respiratory and lab. Large trauma cneter all ER staff in vicinity, code would be called and others from the rest of facility showed up for appearance sake.