So there was this survey thing going on on Instagram and one of the questions were “Favorite nursing task” and my response was “being apart of a code”. So I decided that this week’s post would be about feeling confident in a code. Because, lets be honest, I wasn’t always confident, and you don’t just start out confident either.
So as you guys all know, yes I am an Emergency Department nurse, but I didn’t start there. I started out on a Respiratory rehab unit, and then I went onto a telemetry unit. So when I transferred to the emergency department your girl was clueless. Yes, I had the basis of nursing together, like bedside manner, but I had no idea how to be an ER nurse .As a matter of fact, that overhead page “Code Blue in room blah blah” made me gag for about the first 6 months. But after some practice and participation and amazing preceptors, I got it together. 😊
First thing to remember is that no two codes are alike, with that being said feeling confident is important. Its almost like driving a car that isn’t yours. If you know how to drive, doesn’t matter if you’re driving a Mitsubishi or a Mercedes, you should be able to successfully make it from point A to point B.
Feeling confident in a code doesn’t necessarily mean you know everything but you at least know your resources. A lot of feeling confident in a code has to do with knowing each role and knowing what you have to when you’re apart of it. Once you know your role and its attached responsibilities feeling confident is a breeze because if you don’t know anything else, you know you’re doing what you need to do.
According to the American Heart Association there are 6 roles in a resuscitation.
Position 1
Compressor
Your job as the compressor is to compress! All nurses and doctors in the emergency department are required to be trained in advanced cardiac life support (ACLS). ACLS/BLS certification educates health care professionals on how to perform high quality CPR. Typically, there may be two compressors to rotate in between compression cycles. So if you’re the compressor, don’t worry about anything else but compressing.
Position 2
AED/Monitor/Defibrillator
The role of this person is to make sure the patient is attached to the monitor and place the patient on defibrillator pads. When time is called for a pulse check, the person managing the defibrillator will be responsible for ensuring everyone involved in the code is able to clearly view the rhythm. They are also able to call out the rhythm out loud just to keep everyone informed and so decisions could be made about how the code will proceed. They are also responsible for defibrillating a shock-able rhythm (ventricular tachycardia or ventricular defibrillation). This role is also able to rotate with the compressor in between cycles.
Position 3
Airway
Ideally this role is played by a respiratory therapist providing bag-mask ventilation. But I’ve worked in emergency room’s where there was no respiratory therapist stationed in the emergency department, requiring nurses to take the role of managing the airway until one arrives. Managing the airway includes providing bag-mask ventilation and inserting airway adjuncts as needed (nasal trumpets for ex). In every ER I’ve worked in the doctor was responsible for intubation while the respiratory therapy assisted. After intubation, the respiratory therapist was then responsible for managing the ventilated patient.
Position 4
Team leader
Every code requires a team leader. The team leader is normally the doctor. A good team leader assigns roles from the beginning. They make treatment decisions, provide feedback to staff and makes sure things are sailing smoothly. As a team leader it is best to step back so you are able to get a good view of the room. Keep your team calm and confident, by keeping yourself calm, and confident. I know from experience there is nothing worse than a frazzled doctor in a code.
Position 5
Code recorder
The job of the code recorder is to document everything! You know what they say in medicine, if you didn’t document it, you didn’t do it! Record what medications were given and when, record each person at the bedside and their role, know what time it is for the next medication to be given and relay that to the team leader/medication nurse. Everyone relies on the code recorder for many things. Some facilities have pre-filled forms for you to use, others require you just to document it in the chart. Either way, be organized, make sure the writing is legible, and don’t miss anything! -à (no pressure haha)
Position 6
IV/IO/Meds
This role is simple and my favorite to do. In this role, your job is to establish access and administer medications. Call out the medications loudly after administering, and make sure you stand by your cart. Guard your cart with your life and don’t let anyone in! I remember my first preceptor told me that all the time. She would say, “Stand by your cart Memi, don’t leave the cart!” But truthfully, having more than one person into the cart could cause confusion and medication erros.
During a code, it is so tempting to want to step outside of your role. So tempting to want to help start a line, or to help pass meds, or to just stand there. But trust me when I tell you, they go so much smoother when everyone stays in their role. As you perfect your role responsibility and rotate roles in different codes, you become so much more confident, because you know what you have to do, you know where things are, you know the routines.
Extra tips
*Reach out to your PCT’s, they are so helpful!.
*Delegate to other staff members that are not apart of the code, such as someone to transport labs, bring in meds that are not in the cart etc.
*Lastly, don’t forget that you know what you are doing. Confident or not, you know what you’re doing babe, just tap into it.
Questions? Leave them below or email me at (nursememi@aolcom)
Check out my Instagram page @__thewallflower
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