I have been a registered nurse in the emergency room for 3 years now. While working I have been a part of both adult and pediatric codes. I have my BLS, ACLS, and PALS certifications. Achieving these was one thing, but using them in practice is another. The rumor is that emergency room nurses are adrenaline junkies and we all love codes. We might love the chaotic dance but we need to always take care of ourselves and our teams in the aftermath, because we are just as important as the patients.
When we just start out it is just exciting all the whirlwind of people and the organized chaos that is a code. I found myself just wanting to do compression and be part of the chaotic dance. I first participated in an adult code in nursing school. I was one of the few taking turns doing compressions and I still remember in huddle at the end of the day telling all my classmates about how exciting and exhilarating the code was to be a part of. This was when I knew I was destined for the emergency room.
As my career has evolved and I have become a more seasoned emergency room nurse the organized chaos is still exhilarating but for other reasons. We worked a code the other day for 2 hours. To say it was stressful is an understatement, but in the end it was rewarding. The patient has positive outcomes and should make a full recovery after a successful heart catheterization was completed. In times like the most important thing is debrief and to be able to step away and gather your own thoughts. Once the patient was successfully transported I took a ten minute mental break. I stepped off the unit, got a diet coke, and just took some time to myself to compose my thoughts on what just happened.
The emergency room never stops but at the end of the day we have to take care of ourselves or we will not be able to care for patients appropriately. The other important aspect you don’t think about until after a code is your own level of physical fatigue. Compressions are tiring. Sometimes your adrenaline carries you through your shift but then the next day, you feel like you just finished and intense arm workout. This is normal, but you need to make sure you rest your muscles so they are ready for the next one.
The hardest code for me is always the pediatric ones. The terror in a parent’s voice when they lose their child is simply heart breaking. Those are times I will probably never forget. The worst memory I have was a co-sleeping accident and it stuck with me for a few weeks. The screams of the mother and the mental strain you don’t realize in the moment is there. I never realized how it would affect my mental health. We have amazing support in my emergency room and the chaplains are always available as much for the patients and their families as the staff.
Overall I have learned in all codes both adult and pediatric it is important to know you own limitations. Everyone on the team can be useful, even more so if we pick the right role for them. Some people are great at charting and time keeping where others are IV professionals. In those true emergent situations never be afraid if you don’t feel comfortable in your role to speak up so the patient and you don’t suffer.
The other big take away is to take care of yourself after a code. Each code affects us differently and we need to be honest with ourselves. It is alright to cry. It is alright to be need some time to cope. These are normal things and normal parts of mental health. We have to make sure that at the end of the day we take care of ourselves, because if we don’t we will hit burnout faster than ever and both the patient and you suffer in the long run.
In conclusion, no matter if a code is your first or one hundred and first they are all different. They all affect each individually differently. We need to just make sure we deal with all the emotions and physical soreness that comes with them so we as health professionals do not suffer. Team work is always key and relying on your team members after a difficult code will become more important than you realize until you are in that moment.