Your First ‘Code’

This article was republished with permission from SCRUBS Magazine.

Lately I’ve been reflecting a lot on what it was like being a new nurse. Everybody remember their first code? Here’s a blog post I wrote a few years ago.

Your first 'code' as a new nurse can be referred to as a Condition A or the more popular Code Blue. The most serious of situations any nurse will ever have to endure. The infamous ‘Code’. A place where life and death are literally hanging in the balance. The team that is called when a patient ‘Codes’ is responsible for performing an act just short of a miracle.

Being a part of this effort can be the most stressful experience for any nurse, especially a new nurse.

Your first time experiencing a code is always the worst. As a student nurse you may or may not have been exposed to this type of situation. It’s not like you can show up at school and ask for a patient to ‘code’. So when you finally are on your own, having your own assignments, and have officially earned your title, your first code is always the worst.

It’s quite an intense environment. I mean let’s be honest. The patient is grasping and gasping for life.As a nurse we are all trained in Basic Life Support (BLS) techniques. The last time I checked ALL nurses who are employed to provide direct bedside patient care are required to have these basic skills. So when your patient or a patient on your unit ‘codes’ you at least have the basic life saving skills to contribute to the overall resuscitation effort.(Yes there is far more advanced training involved, but that’s not the focus here).

At least that’s the plan. You’re trained. You’re educated. You’re ready to save lives! Then it happens.You enter that patients room during your first code and POOF!

For some strange reason your mind goes completely blank. You’re looking at this entire scenario as if it’s not really happening and your dreaming. You know you know what to do. You know there are tasks you can perform to aid and assist, but you're frozen.

All you want to do is hide in the corner or at least hide behind someone else so that no one sees you!

You hear people screaming out orders. Asking questions. Performing tasks. All in a coordinated effort.It happens to all of us. (OK, maybe it just happened to me)

That first ‘code’ is quite the experience. You expect a certain type of ‘scene’ and what you see is so very different. I think we are all tainted a tad bit by ‘Hollywood Medicine’. No matter what anyone says, what you see on TV is NOT what really happens.

Having been a part of many ‘codes’ and serving many different roles, I can offer new nurses some advice on how to survive your first ‘code’. There are two things you can do to lessen your fear and become an integral part of this entire process.

  1. Stay as far away from the walls of the room as possible. Be at the bedside. It’s where you will learn the most. Even if you don’t understand fully what is going on, you will at least become familiar with the pace of the overall effort and see first hand how each person plays an important, but very different role.
  2. Know your role. Master it. Each role of the team serves a specific purpose, and the team’s success is dependent upon each role knowing their part and eventually knowing everyone else’s part.

Like anything else you encounter as a new nurse, the more times you are exposed to this the better you become.Remember, at one time, we all were in your shoes.

Stay strong for you and your patients

Anyone care to add any useful tips?


This article was republished with permission from SCRUBS Magazine.
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2 COMMENTS

  1. The other one that sticks in my mind is funny in that sick way us nurses laugh at certain situations. She coded in the center, we put the partitions up and were doing what we could (she was not a full blown code request, just wanted saline intervention, nothing more). The Dr. was in the unit and we had the monitor on the patient, it appeared that her only rhythm was PEA. So we decide to move her back thru the back room over to one of the CAPD rooms until her family came and we discussed her passing. As we are wheeling her in the chair thru the back room, several nurses, techs, and the Dr. The Dr. ask if her daughter was in the waiting room or did she leave during her mother’s treatment, we were all speculating, and the patient….yes the patient….says “I think she went to Kmart”. We all froze, looking at each other, and the Dr. without missing a beat says “Well let’s call Kmart then”. She did pass away later that day at the hospital. I always remember that and was so thankful we had been professional the whole time!! Not sure why it showed only PEA, I guess it was just a low level rhythm or a bad lead placement, not sure.

  2. A bit of a side story. The first time I was dialyzing an inpatient in the ICU that was a no code was memorable for many reasons. First off she called me to the bedside and said “Lora I am going”, and I said “going where” thinking she was a bit loopy from meds, but within seconds her heart stopped, she gave out her last breath, and passed away. Since she was a no code I returned her blood as the nurses attended to her. Had to gather all my equipment to take back to the hemo room. Her family came in and were crying, it was very emotional. For me also as I really liked her and in dialysis you get to know the patients so well. So I get my equipment to the room and start cleaning things. The nephrologist we worked with came into the room, which I found odd, and thought oh no did I do something wrong. She sat down, ask me to do the same, and ask “are you ok? The first time can be hard, when you have to just let them go, honoring their wishes”. I was so touched. We talked a bit and I was ok. I really was, partially because I knew I had honored the patient but mostly because the Dr. cared enough to come sit with me and let me debrief. I will forever respect and care for her because of that compassion.

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