What do you think makes someone good or bad in emergencies?

UM Review RN, ASN, RN · Mar 8, 2006

I get so frustrated sometimes at work. I work cardiac telemetry, and we have a lot of high acuity patients and frequent codes sometimes. I consider myself good under pressure, and I like the feeling of using my brain and skills to the max during a code. I get so mad when some nurse freezes up and leaves the room or someone else has to go code their patient. Not just new nurses, either. One nurse has been there for 30+ years and still I have yet to see her slap that code button on one of her patients. She hovers and flits around until someone runs in there and starts compressions and yells for help. To me, this is just simple incompetency.
I precept and mentor a lot of new nurses - how can I teach this? It seems an elusive quality. I try to look at it like this - the patient would be dead if they were at home, so basically everything you do at that point is helping. There will be one of two outcomes - and it seems to be about 50-50, although we have been lucky this month and I think every one of our codes has lived and done well afterward.
I hate to say that I "like" a code - but I do like the adrenaline rush and the feeling of accomplishment when someone survives. We get a lot of sudden VT and VF - it's just the nature of our floor and the types of patients we care for. We are all required to certify in ACLS protocol every year - so why the lame nurses that run from it?
The way I look at it, if a nurse is going to be that indecisive and harmful to the patient, then get the heck out of cardiac nursing!
Sorry for the rant, just had a bad couple of weeks - tired of working with people who won't get up and haul a$$ and do their best when needed.

I've seen it. Worse, I've done it.

Looking back, I think it's hard to shift out of KNOWING what to do versus DOING what needs to be done for some of us. Lots of us freeze the first few times we're involved in a Code. I think that in that state, people need someone else to tell them what to do.

I had help from some very understanding nurses, and they coached me to a competent level.

Maybe you need to think about initiating Code Practice on your unit for the Scaredy-Cats. We had one nurse bring a video cam and we practiced in an empty room on each other. Then we had our potluck and watched the movie and critiqued ourselves. (It was the most hilarious movie you ever saw, too!)

It might help to have a talk with that nurse, as in "I notice that you seem to freeze up when we have a Code situation; do you need to practice those skills so you can get better at getting yourself through it? Because any Code is all about teamwork, and there's something to do for every skill level."

It'll help if you tell that scaredy-cat nurse do something simple in a Code, like try for a pulse, share CPR compressions, or get the EKG machine, or bag--anything to get her hands going--to redirect that mind-freeze thing.

What helped me was to go to every single Code we had and make myself do something. That needs to be a stated goal for the teaching. Often, they'll be surprised at how much they've absorbed, just observing or helping in some way.

Trauma Columnist · Mar 8, 2006

I've been a nurse for almost 16 yrs and I know my coping skills, assessment skills and just plan ability to my job have improved markedly since I began. To teach this to others who I precept, I start very calmly to explain everything that I'm doing (I work in a level one trauma center). I also explain the rationale for what I'm doing. I then ask for assistance with something small so that the person I'm precepting has a sense of belonging in the code. At the next code, I will expand their participation and keep going until they are doing the directing. After each code, I initially do all the charting, then gradually let them take over.

If it is something that we don't do much like externally pacing a child or something like that, I think through the process myself and might even confer with another experienced nurse myself to ensure I'm doing things correctly. There is nothing wrong with that. Plus, you want to teach correct technique and process.

Good luck...you will probably want to involve the nurse educator and unit manager as well.

student4ever · Mar 8, 2006

I think for some it's an inborn sense - like breathing, no second guessing necessary. For others, it has to be learned. THere are a million things that run through your mind when you encounter a code situation, and sometimes it makes you go "what the heck do I do first, there's so much to do!" But the more involved you are even in simple ways, the more you will learn what needs to be done first, which will help you know instinctively how to behave when you need to initiate the code. Basics, basics, basics... start with the ABCs. Call for help, and check for airway, breathing, and circulation. No need to be worried about anything else until help arrives. One person cannot run a full code alone. For those who are scared or freeze up when they encounter a code, they need to practice being involved in a code. It's easy to just step away and let the more experienced or instinctive staff take over, but if you force yourself to become involved even in simple things, you will over time become more comfortable taking on the bigger tasks. I personally LOVE codes, and take every opportunity to participate, as I know when I'm done with school and a full-fledged ER nurse, I want to know exactly what to do and how to do it at those times when critical thinking is a must and every second counts. The more experience I get, the more instinctive it gets. It's scary when you do something on a real person for the first time in such high stakes situations, but if you never try, you'll never get better.

zacarias, ASN, RN · Mar 8, 2006

when you say frequently, how frequently do codes happen there? On an acute telemetry floor they shouldn't happen that often.

The Sphynx · Mar 8, 2006

The ability to be calm, collect, and clear thinking through it all. That is not

something that cannot be taught.

Dalzac, LPN, LVN, RN · Mar 8, 2006

The first thing I was taught in ACLS was take a deep breath and think. I have to admit though I have seen some nurses who just panic and can't stop and think. Eventually every nurse will have a patient that will code or close to it. Whe I was younger I felt the same way as the OP with codes but after working in icritical care units for 25 years I hate codes. I will work one if I have to or sit with families. The emotions are all high in one I think I got to the point that that is what I hate. Any way that is why nurses like you are drawn to CCU and that is a good thing.

meownsmile, BSN, RN · Mar 9, 2006

Remember fight or flight? I think everyone has a different reaction to that adrenalin rush you speak of. Sometimes its in the genes as to which way we react. Call it our innerself, some are nonconfrontational and some confront. I think the less aggressive nonconfrontational folks will be the ones you find plastered on the ceiling during a code. The confrontational personalities are gonna be right there front n center helpin run that code. Sometimes they just cant help it, be glad you are there.

greenjanell · Mar 9, 2006

with your attitude of loving a code, or loving the adrenaline, you should be in the ER or ICU thats where adrenaline junkies like you and I belong....

clee1 · Mar 9, 2006

I think for some it's an inborn sense - like breathing, no second guessing necessary. For others, it has to be learned.

:yeahthat:

Exactly, IMHO.

Some people are just naturally able to "shift into high gear", let their training and experience take over, then stop to "think" about it later on. I am one of those folks.

It CAN be frustrating... but the key to that is just to take over and do what must be done, then calmly, after the situation, go over the emergency (code, in this case) with the staff that worked it.

Most people will eventually learn to deal with "brain freeze". The worst thing you can do is beat them up about it.

Antikigirl, ASN, RN · Mar 9, 2006

*Education

*Experience

*Confidence

*Ablilty to multitask

*Ablity to find underlying probelms (comes with experience)

*How frequently you do emergency tasks

*Being rational and "real" about the situation (not blow it out of proportion or overstress)

*Calm/clinical mindset

*Supportive team

*Availablity of CME or inservices for questions or refreshing skills

*Good documentation skills

*Good technical skills

*Excellent probelm solving ability

*Excellent cardiac/resp knowledge (EKG especially and the different drugs and actions for different probelms).

*Fluid/electrolye knowledge

I find the best people during codes are the people that are calm under pressure, stick to the task at hand, are well educated and continue annual education or even CME on emergency trends, get experience or have regular frequency of codes/other emergencies, and are confident in their abilities.

Take for example me, I didn't get any real experience or education on codes or cardiac rhythms at all in school...therefore I looked to my hubby (paramedic) and his fellow employees and went on ride alongs and their inservices and training classes. I gained experience by watching and asking questions...taking ACLS and studying with hubby (he and his fellow employees gave me many stories that reminded me of different rhythms and what to do for them and other helpful hints)...and knowing this was something I would do one day!

Then I watched a code at the hospital I worked in my first job...can we say three ring circus??? OMGoodness it was a mess! Interns running around like mad, a doc barking orders before he even got into the room where three nurses were already ready to shock and had IV ready and everything got confused...and a lovely little intern that had a metal doppler probe on a pt right foot in asystole right when they yelled 'clear' (I tackled him before he got it!...I mean asystole, hello no pulse dude!)...

Then 3 years later I had my very own code with a CNA who didn't know cpr. Not only did I calmly instruct her on what to do, but did my own work before paramedics arived (I was in an ALF). I assisted the paramedics fully and was part of the team (they knew me too...heck they trained me on ACLS! LOL). That really was a confidence booster for me, and I just believed in myself and knew I could do it with more practice and education!

I am rusty and could use retraining again since I have switched back to hospital (agency)...I mean heck...ALF I didn't do the meds...let the paramedics do that..LOL! So once I get a few 'watch codes' under my belt again, and reup on the meds...I will surely be one of those nurses helping out and getting it done .

clee1 · Mar 9, 2006

Then 3 years later I had my very own code with a CNA who didn't know cpr. Not only did I calmly instruct her on what to do, but did my own work before paramedics arived (I was in an ALF). I assisted the paramedics fully and was part of the team (they knew me too...heck they trained me on ACLS! LOL). That really was a confidence booster for me, and I just believed in myself and knew I could do it with more practice and education!

Amen! :bow: