Still Uncomfortable with Code Blue

MassED, BSN, RN · Feb 19, 2009

perhaps you can try to write notecards for adult and pedi codes - simple cards with the meds you will need - bold them so you can glance at them as you crack open the code carts. Keep ambu bags appropriate to the patient at the bedside, so you know that is already in the room. Because this makes you feel panicky, I would recommend you drill yourself over and over about what to do in a code - the steps you take - A,B,C - as you drill, you will become more and more prepared. Remember, you're not alone, and you're never expected to handle all of it all at once. Make sure you have the appropriate code cart near your patient - ped cart for a peds, etc. I think your best bet is preparation - and try to maintain composure during all of it - even if you feel a wreck inside. Calm and cool is the goal - breathe. Remember you are not alone. I hope that helps ease your anxiety in codes.

MassED, BSN, RN · Feb 19, 2009

of course I don't work in an ICU - so you have way more meds and infusions than in the ER. I have a critical care pocket guide for the ER - I know there is one for ICU - perhaps you could try that for a reference book?

classicaldreams · Feb 19, 2009

You didn't say the size or acuity of your ICU, so I'm not sure how many you have attended, but I would give yourself more time. I, too, after several years, fine codes difficult. When I'm at a code, usually those with 10+ years are knee deep in it, and so my participation is secondary. If you don't have to man the code cart, try to find an easier task. Perhaps you can be the one responsible for finding the pulse or documenting?

Hope this helps a little. I wouldn't give up on the ICU just because codes are difficult for you. There is so much more to ICU nursing then running codes.

Classicaldreams

classicaldreams · Feb 19, 2009

I think this is good advice. Can you attend a few codes without actually participating? While observing, concentrate solely on your anxiety level. Use biofeedback to learn how to control the anxiety and then remember those steps during the codes you actually participate in.
Classicaldreams

Flare, ASN, BSN · Feb 19, 2009

Communicate with your team. Let them know that you get a bit panicky during codes. This will allow them to understand that yes, you do know where drug X is but you are mildly freaked out. They may also be able to do some code blue drills with you. Prepare yourself -crash carts usually need to be checked once per shift and unlocked and thoroughly checked per your hospital standards. Volunteer to be the one to do that for a little while when you are working.

And don't forget to take one deep breath to calm yourself and focus when the fertilizer is hitting the ventilator. You'll be amazed how well that works.

classicdame, MSN, EdD · Feb 19, 2009

I agree with FirefightingRN. Communicate with your team. Ask for honest feedback. You might find they had the same issues at some point. Also, ask your educator about mock codes or other training that can help. I have little actual experience with codes, but the ones I have participated in EVERYONE was uptight, including MD.

kellykelly · Feb 19, 2009

I hate to admit it but I feel exactly like you do! The adrenaline starts pumping and I'm inwardly completely flipping out. I guess preventing them is more my forte, LOL. I am the only cardiac nurse I know who went a full EIGHT YEARS without having one of her own patients code, and that was starting as a new grad. In ten years I've still only had that one patient of mine actually code. I've had a few close calls that were headed off at the pass. Either I"m incredibly lucky or am really good at sensing when someone is going bad, before they actually do. Probably a combination of both.

I feel a bit inadequate in code situations, though I guess I must do OK at helping out. Mock codes don't seem to help because I'm just a ball of nerves when it actually happens. I find I'm generally the one clearing out the room, fetching things, hooking up monitors and suction, that kind of thing. I don't even mind doing the compressions as it gives me something to focus on. Hell I even had to run the whole show once on another floor, til the code team got there, because I'm ACLS. I did fine that time because nobody else knew a single thing so I was able to pull it together and remember the steps, but I was nervous as ten cats. I wonder if it will ever get to be routine for me?

I've thought about going to ICU or something sometimes because I think I could handle it (worked there plenty of times as a float, though of course being a float my patients were the easiest), but to be honest having to be one of the first responders/code team makes me nervous as can be!

PICNICRN, BSN, RN · Feb 19, 2009

FireFightingRN gave great advise IMO........... ask to be the one to check the Code Cart! Ask your educator or NM if you can unlock it and go through each and every drawer yourself and get familliar with where things are. Ask to join the Code team whenever possible so that you can expose yourself to as many situations as possible. Maybe you can start out being the second RN for meds- checking what someone else has drawn and drawing up flushes?? Unfortunately, sometimes the "experienced" RNs often take over beacuse that is what they are comfortable with- you've gotta let them know that you would like more Code experience so that you can become more comfortable.

tryingtohaveitall · Feb 19, 2009

Here's another tip for you. Think now of certain tasks that always need to be done in a code. When someone goes, you start doing one of those tasks that you know need to be done immediately. I.e., early in my ICU career we didn't have prefilled saline syringes. When someone would start to code, I'd grab a handful of syringes and vials of saline and start drawing up for all I was worth. :>)

Having something to do will keep you from floundering around and actually doing something may help to calm you down so you can think more clearly about what else there is that needs to be done.

Once you get comfortable at this things in a code, branch out and offer to do the documenting, or drawing up meds, doing compressions, etc. Hang in there! I totally agree with the others, getting nervous in a code absolutely doesn't mean you aren't/can't be a great ICU nurse! Heck, I would venture to say most/all of us get nervous in a code. You're supposed to have a huge influx of adrenaline! (hug)

**canoehead, BSN, RN** · Feb 20, 2009

Check the crash cart until you know it from memory.

Think about "what if" situations, what would you need, and where would you get it. Mentally reheorifice your actions, and you'll know what you need to research or ask about before the crisis happens.

Slow down. In a crisis it's tempting to rip everything open, and in actual fact nothing gets done, no brain cells are actually functioning. Ever run into the supply room and not see the equipment that's right in front of you?

There are usually lots of people at a code. The doc hollers out "I need X!" You yell "I got it" and then go do it- just that one thing, and try to block out the chaos. You will be more likely to hit the vein, or find the equipment if you concentrate. Pick something easy, be successful, then move on to the next task.

You can't hurt someone that is already dead, do your best, think about how things could have been better, but don't go on a guilt trip. Guilt will make you clumsy next time, but honest critiquing will make you smarter.

No one is expecting you to do everything. If it's my patient I stand back just a bit and try to coordinate and delegate. Call for the NGT once the ETT is placed, make sure the suction is available for ETT and oral, and NGT, keep track of that little white connector on the NG, and the tape roll, and the 10cc syringe with your eyeballs. Think about the pt history and how it fits together, and what you will need once the patient gets a heartbeat (respiratory, Xray, labs, another IV, drips made up).

Virgo_RN, BSN, RN · Feb 20, 2009

Everyone has their own internal response to codes! I like the idea of asking if you can do the code cart checks. Also, since I haven't read all the responses so I don't know if anyone has already suggested this, grab the log and be the recorder. Being the recorder means you have to pay attention to what's going on, but you don't have to be involved other than writing down what's going on. I'm really uncomfortable with codes still, and haven't had my ACLS yet, so grabbing the log sheet is what I do. There are certain things I learn better by being able to observe a few times, and codes are one of them.