Code Blue: Where Do I Stand?

As difficult as it may be in this kind of situation, with emotions running high and when every second matters, staying calm and in control is vital. The last thing a critically ill or dying patient needs is a room full of healthcare providers who are so frantic and distraught that they can't think or act logically. Usually, just one person who takes charge and directs the flow of everyone's coordinated actions helps to create a calmer atmosphere. That's why in BLS/ACLS training, knowing your role and using concise communication with the team is taught. I try to use every code or other emergent situation I am involved in to build on what I could improve on. Staying calm is a skill, and it takes time, experience and evaluation of previous situations to develop.

As an upcoming nurse I thoroughly appreciate you writing this. It is realistic and informative. Thank you

[COLOR=#000000]I have seen the madness that can occur in codes all too often. For some the ego of one provider conflicts with the ego of the others, sometimes you only have under-educated staff to assist, and other times despite everyone's best efforts and a "flawless code", the patient still dies. I am glad to hear you are taking this on as an improvement initiative at your employer. Others would just say "this is how it is". We should never stop trying to improve ourselves and the outcomes for our patients. [/COLOR]

I really enjoyed this article and the perspective of a young, "up and coming" nurse. The compassion present in the narrative seems genuine (Nursing must be your calling, LOL) and the quest for improvement is loud and clear, as well as heartfelt. I applaud these qualities in you!From a somewhat, "crusty" CCRN, Flight Nurse and 20+ years as an instructor in BLS, ACLS, PALS and NRP (formerly NALS) perspective let me offer these few guidelines: 1) Training should be taken seriously at all times, especially when trainingis taking place. 2) Repetitive simulation is effective for serious training to succeed.3) When the "real thing" happens you will only be as good as your trainingand experience permit.4) Never "blow off" hands-on skills thinking that you already know them!5) Teach and encourage your colleagues!6) Apply diligence to being prepared through training (what if scenarios)7) If IT IS your day to go, you cannot stay; if it is NOT your day, you must go.Check out the poem by Rudyard Kipling: "IF" (don't be offended by the last line, He's talking to his son).If you can keep your head when all about you Are losing theirs and blaming it on you; If you can trust yourself when all men doubt you, But make allowance for their doubting too; .....Thanks for sharing! Much more could be said. NURSE ON!

Great article. I haven't participated in many codes, and I will tell you they terrify me. But it is more the fear of the unknown. We have several mock codes each year and my hospital does offer code blue classes run by the ICU nurses that really break it down - they get you hands on with some of the medications and the procedures, and it helps immensely. Every time I take it I leave feeling "refreshed" and confident that I could react accordingly in a code situation.

This year I will have been a nurse for 27 years. I have worked in many environments. I have learned a lot of complex information, fancy drugs, procedures, pathophysiologies, but I have found that often what brings success with patient's outcomes are the basics. ABC-airway, breathing circulation. when you are faced with a situation if you take a deep breath and rely on training and repetition and I would say, if you don't have the luxury of a simulation lab, close your eyes and picture the situation and yourself walking through it adn do it over and over until you are comfortable. When you encounter a code, which is often the most terrifying thought a nurse faces daily. You can face it calmly and with the assurance that you have the tools to do the best you can, ABC. When you look back to decide if you did all you can in a bad outcome, the answer is, if you covered the ABC's, you more than likely did. We never have full control over a person's destiny.

Nice writing on a difficult, frustrating situation. Sorry about your friend. Some loses are harder than others, and I know that coding your friends and loved-ones ranks among the "toughest stuff" in nursing. Also, add situations where you may care for and even ultimately have to "code" co-workers in certain nursing jobs and it brings a new meaning to the phrase "rough day at work". Recognizing that the situation was so uncomfortable that it spurned you to want to make changes is a good thing. It may not feel that way, but a situation that strongly impacts you can serve to bring a very positive change. Although you have only been a nurse for a few years, if you are fortunate you will continue to have situations that challenge you to want to make changes your entire career. I do hope that you have less heartache, but even the experience and the most awesome ACLS skills will not protect you from that, I'm afraid. That "discomfort" has happened to me several times through the years and I always called them "shaping incidents". These are the events in clinical practice that serve to drive me to a place of growth. And from this place I made strides as a clinician and sometimes personally. Most of my "shaping incidents" had a few commonalities. Generally, they were "high stakes" situations—either for the patient or me or both. Often, these were "spinning" situations —lots of people involved and lots of moving parts. Although not all of the "shaping incidents" involved a bad outcome, many were less than textbook ideal. The real gift of these experiences started after they were over and when I started looking back to go forward. Could this have been handled differently? What could I/we have done different? What went right? Wrong? Who/what worked best? Who/what didn't work out so well?As difficult and frustrating as it may be, that's the way growth occurs. I always tell tell folks to make their clinical practice "comfort circle" as tight and as absolutely solid as possible. Know your stuff cold. Up, down, right, left. In the rain, on a plane, on a train, through the grain, and the insane. (My apologies to Dr. Seuss). But the fact is, when you are stressed, you come back to your "comfort circle". You always come back to what you know and know cold. So, what do you want in there? When you start out your circle is small. You may only know where to stand and not get in the way. But, that needs to change and change fast. You determine your "comfort circle"! Be brave. Take the classes. Be the "go to". Step up. Stay current. Your "comfort circle" will depend on constant review and renewal. Keep learning, stay fresh. Be the best you can be! Practice safe!