Living in Quebec, I have a cegep degree in Nursing and have already been working for several years in the field at the Montreal Children’s Hospital. I have been working on my Bachelor’s degree through Athabasca to further my education and increase my knowledge and skills as a Nurse. I started my career in Pediatrics, on the post operative floor, and eventually transferred to the pediatrics recovery room, where the care and patients are higher risk as they wake up from anesthetic. Working on both units has offered valuable insight and experience in life-saving techniques and emergency care.
When I began my career as a Registered Nurse, there were opportunities offered to me that were invaluable and crucial to building and expanding my capabilities to offer life-saving care. This began with CPR training. I absorbed the training and participated through out the course, asking questions and clarifying information that was unclear. This is a necessary and crucial base to any Nurse, not only being CPR certified but having confidence in your skills to perform CPR.
During my orientation on both units, a priority in training was to know the location of emergency medications, their names and what purpose each one serves. On my own time, I researched these medications more thoroughly to increase my knowledge base so I can maximize my being helpful and efficient if ever there was a need for these medications. In the recovery room, during an on-call shift, where we were only 2 nurses, and a patient stopped breathing after receiving several doses of Morphine for pain control. The anesthesia team was present and my colleague stayed with the patient as I was instructed to prepare Narcan. I had previously practiced preparing Narcan using saline as a substitute so I would feel confident in my ability to prepare the real emergency drug if required in the future. This proved vital as I was able to prepare the medication quickly and efficiently during this emergency situation, where it was subsequently administered to the patient who immediately began breathing again.
Know the Protocols
During a shift in the recovery room, a child with a tracheostomy underwent a procedure called a “balloon dilatation” to expand her airway with the goal of eventual removal of the tracheostomy. Due to COVID protocols and the potential need for AGMP (Aerosol Generating Medical Procedures), she was placed in our negative pressure room, along with myself and a second nurse. While she was waking up, she kept pulling off her saturation probe which consequently gave a reading of 0% on our monitor. Although we attempted several times to place the probe, we could see that she was breathing through her trach; we saw her chest rising and falling, as well as maintaining good color. However, that did quickly change. Thick mucus began clogging her tracheostomy. I immediately tried to suction the secretions but they were too thick and too deep. She was clearly in distress so I called a code blue by pressing the emergency button on the wall while providing oxygen, until anesthesia arrived and took over. Calling a code blue seems like a simple and easy solution to a patient being in respiratory distress, but in my experience, it takes a level of confidence to make that call. I’ve had discussions with nursing students and new nurses about these situations, and they have expressed concerns, such as, feeling like they have exaggerated if they call an unnecessary code blue, along with feelings of embarrassment and insecurity if calling the code was ultimately not needed. I have felt the same way as a student and as a new nurse. What is important to remember is, what is the alternative? What is the worst that can happen from calling an unnecessary code blue? More importantly, what is the worst that can happen by not calling a code blue when it was in fact needed? The code blue team will arrive on the unit but not actually be needed. This will create a great learning opportunity for what the student or nurse could have done, and what they can do in the future before calling a code. But the important aspect is, no one was hurt by making this call and the patient remained safe. Not calling a code, or taking too long to realize that the call needs to be made, can obviously put the patient in extreme distress and could be life-threatening. This will also create a valuable learning opportunity but with potentially dire consequences. From what I have seen and experienced, activate the protocol and make the call.
Mentally preparing for life saving care, in my opinion, is more important than any physical component to emergency care. During the urgency, panic and sometimes chaos of an emergency, it can cloud anyone’s judgement. Staying level-headed and calm can be the difference between preparing the correct medication, preparing the correct dose, and most importantly, potentially causing more harm to the patient. I have seen and been involved in several emergency situations, and although each time is just as terrifying as the last, remaining calm and focused will enable you to provide better care.
Trust Your Education and Instincts
For most nursing students, “Remember your ABCs” is a phrase that we will never forget. When assessing your patient, pay attention to airway, breathing and circulation. These 3 details will answer a lot of questions regarding whether or not there is an emergency situation. Remember what you have learned in school, and trust it along as your instincts. If something doesn’t seem right with your patient, trust that feeling and seek help.
Leave it at the Hospital
Eventually, regardless of the unit, nurses will either observe or be directly part of providing life-saving measures. As mentioned above, it can be scary, overwhelming and even traumatizing depending on the outcome. As difficult as it may sound, for a nurse’s mental health, he/she needs to leave it at the hospital. During my first year as a nurse, I often emotionally took my work home with me. I found myself thinking about my patients, how they were doing, and even calling the unit to check on them during my time off. Although compassion is a common trait among nurses, it is primordial to learn to turn it off to avoid caregiver burnout.
Students and new nurses will have a lot to learn regarding preparing physically and mentally to provide life-saving techniques. It is an ongoing process that will take practice, but is also a lesson where there will always be something new to take away. Being prepared, knowing the protocols, trusting your instincts and asking for help are some of the strategies to better prepare for these stressful but inevitable situations. Being as prepared as possible will provide the nurse with the confidence and knowledge to give the best care for his/her patient during a time when our best is needed.