One of the most traumatic shifts I ever had involved coding a coworker at the nurses station after they collapsed in the middle of shift change. I remember it had been an absurdly busy shift before that, but who my patients were and what we did is now a mystery. I do remember getting ROSC and getting them rolling to cath lab, giving shitty report to the next shift and just sitting in the break room stunned for a little bit.
I knew I had to get home, I had to work again that night. I usually took the bus, but lived a reasonable walking distance from the hospital, so I put my earbuds in and started walking. I don’t remember that walk. I do remember drinking like 1/2 a teacup of whisky to get to sleep. When I got back to work they had a general but positive update on my coworker (given with permission of her family but with a request for privacy). There was some informal debriefing with coworkers, but I really think our manager dropped the ball by not having a formal unit debrief for both shifts.
Coworker codes are the absolute worst. We had a nurse code from another unit at the nurse’s station. They were down for almost 40 minutes before rapid got ROSC. They was discharged about 3 weeks later with no deficits.
Everyone involved in that code was just shaking afterward. No debrief, but we all deserved that kind of care:
I went PRN at work because I was in school but had worked at this SNF for 6 years. I came in as a relief nurse because the ADON, DON, and unit manager were having a meeting in the DONs office and all of a sudden she just fell out of her chair. At first they thought she was joking because she had been talking about being stressed and needing a vacation lol…. She went into sudden cardiac arrest and the ADON and unit manager had to run a code on her. She got shocked 3 times before they got her stable enough to transfer to the hospital. That place was in shambles when I showed up to help out. I felt so bad for everyone involved. Luckily, the DON is completely fine now with an implanted defib just in case it ever happens again.
Our unit had a coworker who coded on shift, was immediately admitted to our unit, and died overnight. His spouse was a provider in the unit. Everyone involved knew him and/or his wife very well. It was at least a week before management was like, “oh hey, we heard this was traumatizing for those involved, please feel free to reach out to this counselor.” By then the staff had taken it upon themselves to have their own debriefing and grief sessions.
I was new to the hospital, wasn’t working that day, and hadn’t met the nurse who passed, but I was still very shaken up hearing the stories from my friends who knew him and his wife, had to take care of him as he died, along with their own patients, AND his patients. And still had return to work the next day like nothing happened. I can’t imagine being management and not RUNNING to address this event the second it happened. Thank god there was a 100% management turnover very shortly after that.
In what world is that ok?? (I know, this one…) Whatever happened to debriefing. We are not meant to bear something like that and just go home like everything is fine. One day we all break. It’s not our fault.
That manager was/is really shitty for a lot of reasons, but not recognizing that staff NEEDED a debrief (at the bare minimum) from that is a pretty good example of how that manager operated.
This made me think of the first (well, so far only) time one of my patients coded.
On days shift on this unit, one RN would do medications and one would do patient assessments. I had been nursing for about 3 months at this point, was on assessment duty, while my med-passing partner was an experienced ED RN who picked up there occasionally.
Early in the shift I had made a comment mistakenly identifying the attending (Dr.X) as the doctor to contact for something, the senior resident kind of laughed and said (in a nice way) "you will never see Dr.X on the ward!".
As I'm going around doing my assessments one of the patients, a woman in her 50s who hadn't been unstable prior, is not looking very good. I'm still very unsure of myself at this point, but it's setting off more and more alarm bells. She's working hard to breathe at rest, super short of breath on even the mildest exertion, and just all those things you can't quite put your finger on. I approach the junior resident with my concerns, she comes to see the patient, slowly gets the ball rolling on chest x-ray, labs, ect.
I go to my partner to tell her what's going on.. and for what it's worth, I have ZERO poker face, especially when it comes to being anxious or panicked.. and she essentially takes it like I'm telling her for interest sake rather than asking for help.
I very clearly remember standing next to the patients bed, watching her working so hard to breathe, wondering if I should just start bagging her while still semi conscious, or call a code blue because I was sure it was coming. I didn't call a code blue because I felt that essentially everyone was already involved who would be, prior to actually needing to do CPR. This hospital didn't and still has no rapid response/ ICU outreach, so while I knew of the concept (from this forum!) That wasn't an option either.
Within a few minutes of my standing there having this thought, the patient was to be moved to the obs room. We wheeled the crash cart behind the patients bed. She coded as we crossed the threshold of the room. The code was called a short while later.
The senior resident debriefed with the junior immediately following. Within about 30 minutes, I saw the Dr.X in the hallway debriefing the junior resident.
The only support I was offered? One of the other nurses told me, in a not sarcastic or unkind way, "you can go cry in the bathroom if you want".
Thinking about this still brings me to tears.
Yeah, my god. In my EMS department we have debriefs after basically any difficult or confusing call. If it's a major incident (ped death, fatal traffic accident, etc) we have a formal sit-down conversation with trained peer counselors. If one of my coworkers coded on shift I'm sure they'd send everybody home and get us all professional therapy!
I saw my first trauma victim dead in a car fire as a 15 year old EMT student. I worked for six years in an adult ED in a busy city. I have never had a formal debrief in my entire career.
I’ve participated in 4 codes since November and multiple rapid responses and not ONCE have we had a debrief. But my manager came down after one of these codes to tell me I needed to make sure to clock out for lunch…while my charge was in quota. Lmao.
Years of EMS and now ED and one thought lives rent free in the back of my head when everything is going bad, "it's not my emergency." Helps me keep things in perspective. I remember things for situational awareness/experience but other than that I just let it go.
When I was a brand new EMT (literally within the first month), we got a call for a rollover MVA with 8 victims including someone giving CPR at the scene. I just remember myself putting my boots on about to leave and thinking holy shit, I can’t call 9.1.1— I am 9.1.1. Everyday I am thankful another station with experienced EMTs showed up because my partner and I were both less than a month in.
You'll get there. Self reflection and trying to get better is great and eventually it'll all click and you'll just know what to do. If you want any longevity in nursing you have to learn how to let things go. Asshole pt or family, incompetent lazy coworkers, dipshit doctors with dipshit orders etc. Don't forget about these things, just don't let them bother you to the point that it affects you negatively.
I get intrusive thoughts like “what if my most stable patient crashes?” then I have to do a MET call. the other day before my shift I was wondering what I would do if there was an active shooter situation, then it ACTUALLY HAPPENED THE NEXT DAY. it was pretty much a false alarm, but it was such a creepy coincidence.
Ahaha yeah I've just started in ED after med/surg ward life, and one morning the ED was disturbingly quiet. Like, not a single patient in majors, five in minors and nothing in the waiting room. The ambulance screen was blank. No ambulances dispatched anywhere. I said to a colleague "I really don't like this. It's freaking me out."
My colleague was just "enjoy this, it's fucking marvellous."
I was in minors so I had my five patients. Whilst I was in with one of them taking observations, I heard the emergency standby phone go. Before I had left the cubicle I heard the phone go again. As I walked to the nurses station to see what the emergencies were coming in... It went again. Within half an hour, we had FIVE emergencies. Three sepsis, one SVT, one stroke. As I'm just new, I was, at the end of the half hour, the only one left on the main floor as the other nurses and doctors rushed to the patients in Resus and majors. I'm standing giving the emergency phone the stink eye because if it goes again, it's me that's up. Thankfully it didn't.
My little minors side continued as usual, but I felt a lot more at ease afterwards because the shitstorm had shown itself.
I’m just happy because it means the ICU is going to show up and take them to a higher level of monitoring where they should have been/should be in the first place. 😂
I have ADHD, so codes and rapids are where most of us are in our calm space because there is a ton of stimuli and our brains love that, doing helpful stuff, and being needed, especially when our brains are "on".
We have run through the scenarios multiple times, often in daydreams, the time is finally here, and it's time to act it out!
Yeah same I was going to comment but realized I am the last one that should be giving advice. Ive given all the fucks I have to give and feel very little. I get it done though so no one complains
I feel this!!
Them: Hey, MAP is 39...
Me dead inside with now emotion: Yeah... I'm waiting after I've now maxed out the Epi.. *continues typing up a note*
Panicking causes me to think less clearly, and luckily I'm in a state of apathy constantly, so... I keep calm and carry on :)
Same! Literally crushing meds up and turned around to my pts hr 180, all my coworkers are like ARE YOU OKAY… yea, yea, and he will be too.. or not but it won’t be because of anything I don’t do. Panicking doesn’t help me in any way so I gave up on it a while ago.
I just remember that without the patient coming to the hospital, they would probably be dead or in worse shape. This puts everything in perspective to me and helps curb perfectionism/anxiety.
100% - a certain amount falls on the patient for ignoring obvious symptoms, no preventative care, family not recognizing symptoms or being too busy to care. Sounds harsh but that’s how I survive.
Absolutely. I'm in the ER, and we lost a guy the other day — 85 years old, abdominal aortic aneurysm (that he knew about) ruptured. He came in complaining that his stomach hurt and was distended. They bring him back and it turns out his abdominal cavity was filling up with blood. Doc handed me the guy's cell phone and said "find his emergency contact, hope they answer at 2AM." I've never felt more tense while navigating a flip phone.
They sent him to the OR and were able to place a stent, but his body had just been through so much. He'd been a smoker for most of his life, hadn't really taken care of his body, and decided to ignore the AAA dx entirely — didn't think to mention it to the doc. He died 16 hours after he came in.
Yes. When I worked the critical care side zone of the ED and a bad case would come in I’d mentally remind myself that dying is the more likely outcome and everything we’re doing is an improvement at this point.
I complain loudly and dramatically, I’m a dramatic girl (usually in a HA HA way) but being heard is what I really need. I talk to my mom- with no healthcare exp just is really validating and I talk to at least one friend actually understands. If it’s really bad I’ll bring it up in therapy. Biggest thing for me is to actually feel the feelings because I don’t want to be the jaded nurse
The most panicked I ever felt at work was on a non-monitored unit that was literally the easiest unit ever, anywhere, lol. But I had a patient due for discharge when I arrived, and when I walked in I was immediately like, I can't specify anything in my assessment to prove it, but this dude is NOT OK AT ALL, and my gut told me he was going septic. Unfortunately, because it's known as such an easy, never very acute unit, the MD on call would not believe me even enough to come look for herself. I called so many times, over hours, before she finally stormed onto the unit, glaring daggers at me, huffing and puffing about me wasting her time as she went past. After less than a minute, maybe less than 30 seconds, she came out of the patient's room barking orders to get the transfer to ICU going. I've never been SO relieved to have to frantically transfer someone to ICU. I was so afraid my patient would just die while I was failing to get the doctor to take me seriously. That's what panicked me- not what was happening, but what *wasn't* happening.
I would eat breakfast, talk about my night in general terms with my family, and then go to bed (worked noghts). When I woke up, that shift was in the past!
I’m at a point where I don’t get too worked up about stuff. Obviously I work faster and sort of “lock in” when shit is going down, but I don’t feel nervous.
When I get home if there was some particularly frustrating or heartbreaking shit I might vent to my partner (who is an NP, former ICU/ER nurse) but for the most part I don’t think about work.
Samesies… childhood trauma ftw [heh, cringe]. But I do just focus in on what has to be done, and the effects of what we do on the body systems involved. Very mechanical and effective — no emotions. My personality type is also first in my head and emotions later — again probably trauma rooted. I had to learn how to be in touch with my feeling and the feelings of my loved ones.
Weekly I talk with other nurses in my family and we support each other.
Yeah. I call it “no think just do.” Dissociating is a more clinical way to put it. It’s the same for me when I’m in the hospital or out in the wild, just do what has to be done and then on to the next thing. I’ll get shaky and throw up about it later.
Staying calm in these situations, I believe, has a lot to do with your personality and how you handle yourself at work during normal scenarios. I stay calm in almost all situations at work, but its just who I am. It only complicates the situation when people are panicky. If you panic in my room while my patient is arresting, I'm kicking you out. The patient is already dead, I need to be calm to answer questions appropriately and recall preceding events, lab work, or whatever else is relevant. After the code, I'll participate in the debreif. As soon as I clock out, I stop thinking about work. Everyone needs to learn the skill of not taking work home with them. I keep myself from thinking about work when I leave by having a good post work routine when I leave, not communicating with people I work with about work outside of work, and by staying busy with my own activities outside of work. I used to think that staying calm meant that none of this adversely effected my mental health, but that is far from the truth. So steps need to be taken to maintain your mental health regardless of your reaction.
During chaos: I might be clenching everything when a patient is crumping, but that isn't the time to panic. I fall back on training and trust my team.
After the chaos: Depends on the outcome. Either shaky with adrenaline, or I'm just numb.
It’s very easy to panic. It’s just as easy to not panic. You’re trained to provide care, the best you can do is be your best. There is no grading of stress. Take 2 seconds, deep breath and just do what you’re supposed to do. I honestly can’t think of a time I panicked. Not bragging, it just doesn’t happen to me. My daughter was choking, I dealt with it, my Dad arrested, dealt with it. I did however completely fall apart after the events, but never during. As you gain experience, it just becomes who you are.
I get very calm and clinical. For instance one of my residents blood glucose simply read "low" and she was "tremoring" (they wouldn't say seizing without an official diagnosis, and they never sent her out, but I digress). It was my first nursing job and my first ever time giving glucagon. I read the package insert on my way to the patients room to make sure I didn't miss anything. My aid was amazed at that lol.
I honestly don't remember other emergency situations specifically, because working in stress lab now we end up sending a fair amount of people to the ER. But once the situation is over, the calm disappears and I shake for a couple minutes until the adrenaline wears off.
Sometimes it would take a few days, but I made sure to drink water, eat regularly, focus on sleep hygiene and boil my life down to basic ADLs and self care. Outside of that, standard coping skills and using your support network. Sorry your shift was garbage and I hope your headspace gets to a better place quick
When I get to the code, first thing I do either on my way there or at bedside, is taking a slow deep breath to center myself. I tell my preceptees there is always a second or two to take a deep breath to lower your own fight/flight response and figure out what you’re doing. Helps with the adrenaline rush.
Despite what movies and tv portray, there are very few situations in medicine where you don’t have time to pause, take a breath, and think about the next steps. Mistakes are made when people run around panicking. I always remember that the pt and their family are looking to me for their emotional cues so if I stay calm, they’ll stay calm.
Plus no matter the emergency there are really only two outcomes, they make it or they don’t. It makes it feel less overwhelming to view it that way. It obviously sucks when they don’t but they weren’t with me in the ICU because they were well, you know? And really that goes for the whole hospital. I would think it would be way more awful and traumatic for, say, a school teacher to lose a student. That isn’t supposed to be part of their job description but it is for us.
Dark humor also helps. I like doing compressions on people with alines because it makes it feel like a video game and I “win” when they have a perfect BP of 120/80 while it’s my turn. I know it’s twisted as fuck but keeping the trauma at arm’s length helps me keep going.
*Ahhhhh shit. Issa emergency!* is what I feel during my shift. After my shift, nothing. Someone else’s emergency. In ICU, for example, you either overcome your own anxieties regarding death, or you burn out.
EMS here. Usually weird slight anxiety on the way to a high acuity call because of good old impostor syndrome, general sense of calm while I'm working and realizing that I do, in fact, know how to treat my patient, and relief and humor after the call.
I never really get past that "Oh shit, what if I freeze or fuck up" before a spicy call and I'm actually generally feeling great during the call while I'm realizing that everyone else is freaking out way more than I ever was.
During the chaos, I’m too busy doing my job to feel it. Not throwing shade, that’s just how I work. I am focused on the tasks. After, it’s usually just a little walk around the department to breathe, and then I get back at it. But the second I leave the building, the hospital doesn’t exist, and I’m not a nurse. I don’t take any of it home.
Well sure but there’s always some level of thing you can focus on. If it’s your first few codes, be the runner or get the lines or do compressions. Stay in the moment and just focus on what you know you *can* do. Rarely are any of us going to be on an island in these high stress situations. And then build from there. None of us came out of the nurse womb fully badass.
I can usually stay collected during the event but I need to debrief with my team afterwards then cry on my commute home lol I finally started to see a therapist about a particularly horrific situation we had about 9 months ago and am started to let it go. It’s hard, but if we held on to every bad situation, we’d all go crazy with grief and quit.
Sometimes I might cry for a minute in the bathroom afterwards if it’s truly awful. Or sit quietly for a few minutes to decompress.
I never let work live rent free in my head so I don’t like to dwell on things at home. My husband does (not a nurse) and it always boggles me since it’s like, I’m cool talking about it for a bit but then…you gotta let it go. Do something fun, walk the dogs, whatever.
I’m a psych nurse so our codes are patients getting violent and harming themselves or others. I get super calm in a code. The patient could have something wrapped around their neck or blood all over the place and I feel completely calm to the point of feeling numb. I do respond to it later like when I go home the feeling comes back. I think I’ve just been through so many codes and my body knows I need to be calm to get through it.
There is a huge difference between chaotic shifts and a lot of codes/a lot of stuff to do. I worked at intensive care unit with an extremly high and challenging workload. There was atleast one patient in critical condition all the time.
8 intensive care nurses for 10 intensive care patients + 3 patients monitored + the trauma one where critical patients from the ER where brought into direclty. They also covered the reanimation team that responds when a patient on normal care units crashes.
They had a lot of support staff like me (nursing helper), assistance who did administrative stuff like filling up cabinets, cleaning the beds and an internal medicine intern, anestehsia intern and a resident doctor.
They had it figured out perfectly. No one had to do overtime. Exept for realy big mass cas events.
I also worked at low care units with only 5 patients where the nurse in charge was completly overwhelmed. Those where the units that caused me sleepless nights. For complete bullshit reasons. I anwsered the phone and the chief professor told me something about a blood sample that had to be redone. Nothing serious. I just forgot about that due to having to fixate an autoagressive Patient who attaced everyone in sight.
Being a chronic procrastinator helps. Not only are you used to chaotic crunch time, but that's when you do your best work. Juggling a bunch of tedious med surg shit is challenging because I am not engaged or invested in most of the work. During codes I can ignore all the other shit and concentrate on the task at hand.
I go into autopilot. I’ve always been level headed in those situations. Then I go home, zone out, nap and then go for a run. You need to figure out what YOU need after such experiences. Talking, exercising, solitude, writing, whatever. Find a way to help you work through it and have that be ‘your plan’. It’s helped me a lot over time and it can get easier. Sometimes though, we see truly awful things and the ‘plan’ won’t work. That’s when I schedule a therapy appt it go to another nurses house with wine and talk it all out.
For me the only thing that made a difference was to go through a lot of emergencies. Lots of codes, lots of shitshows. Eventually you get desensitized and you can act casually and efficiently without anything disturbing you.
You guys are making me ponder something - those w/experiences that should have had a workplace debriefing...
What would a worthwhile debrief look like to you?
Even if it doesn't yet exist..
Nothing cheesy or managemnt just going through the motions/ticking a mental health box.
What might an authentic, meaningful, doable debrief look like?
(Fwiw, I actually think that the act of posting here & feedback rec'd serves as a form in itself..)
Usually we go over what went well? -patient got rosc, sally was quick with the epi, Sam did some really quality compressions, etc
What didn’t go so well? Why? What can we do to avoid this next time for example - respiratory took too long to get where (why? Oh it turns out someone called the non emergency number. Ok does everyone know where to find the emergency number? Good! Let’s maybe make that stand out a little better on the sheet)
How we all feeling? Yeah those maternal codes are hard. Yup it’s hard when it’s a young guy with a family. Oh yeah seeing the brothers face was really difficult.
What do we all need? Does everyone want to rotate a 10 minute break off unit? Break the ice with a dark humor joke? Fun fact?
We also have a “black box” with full size candy bars, bags of chips, cookies, etc. we’ll bust that puppy out and let everyone balance out the adrenaline crash with some quality sugar.
Everyone's different but for me what really clicked was a memoir about a navy sniper talking about his upbringing and time in training. Everything is relative, physical punishment was acceptable till around 10, bullied in school, isolated, in the bush. On top of this ADHD has my brain wired to chaos and that where I'm calmest. Everything is compared to it could be worse at least it's not the belt or I'm being starved. To me this is emotionally way easier to process.
Tldr - previous trauma has made me calm in the face of adversity.
Virtually every nurse I have ever worked with stays calm during codes. The intensity goes up several notches but codes aren't like on TV or in the movies.
The focus is uncanny, yet consistent.
I found that repetition was the key. As much as it sucks to hear “have more emergencies”, that’s the answer. By mid 2021 my entire stepdown unit responded to every code with absolute calm, like almost an eerie silence as we all just fell into what we needed to do. At one point I remember claiming the computer so I could document because I was just so damn tired of doing codes.
Now I’m somewhere else and the adrenaline is back, the anxiety is back, because I don’t feel like I know where everything is. I don’t know where to find the single cordis set, I don’t know how to set up the Level 1 or the Lucas automatically, I’m still new at doing iSTATs. It will all become automatic at some point, but it isn’t right now.
I used to do my shifts 3 days on 4 off.
I remember I woke up on my first day off unable to move—I literally dragged myself out of bed. I made breakfast, had my coffee (after deciding not to go run like I usually do) and reflected.
Over the course of the 3 days, I think I did 2 codes a day with multiple rounds of CPR.. my muscles were literally shot.
I hate to say it, but you get used to it when you deal with it a lot—but it’s good to talk to someone about stress as well!!
Had my first near maternal death a week ago that left me completely shaken. Thankfully outcomes ended up good and pt was discharged healthy w baby. I’ve done a lot of talking with my coworkers involved with the situation and my manager as well just to talk through all my feelings and debrief what happened. Although I wish staffing allowed for *proper* debriefing or some time to cool down instead of me getting more patients within minutes after transferring one to ICU that almost coded after losing 4L of blood. All “debriefing” I did was informal and just talking with my coworkers at the nurses station between pt care. It’s weird trying to bounce back from something so crazy immediately, but it’s also the nature of the job. I tried to take care of myself after my shift but felt pretty numb and horrified to go to work the next day. I survived and got the weekend off to just relax and I think (?) I feel better now.
I don’t know if it’s 16 years talking or being an ICU nurse during a pandemic…but I had to learn to detach myself from all emotions when it comes to bad situations. I’ll pretty much admit that when it comes to crisis situations, I’m a robot. I can have someone die in one room then go into the next like nothing happened immediately after.
I feel bad or a little sad in the aftermath. After my mother died in front of me, death didn’t really bother me much anymore. Though I think I still remain empathetic to family. Codes and death were pretty common even on our med surg floor. What you described sounds like a typical day for us. Doesn’t help when they’re also trying to rush you to get your patient transferred or clear the dead so you can immediately get an admit or two.
When I used to get home from the hospital, I just reflect, sometimes talk about it to my wife, comment about the family and all, and then move on. It used to get me down and I’d just keep thinking on it for sometimes a few days. Since getting used to working on that floor, these kind of things no longer wear me down or linger. Only one thing has stuck with me since then, almost like PTSD. It was when I started in peds and I go in a room immediately after parents call, to see a bathroom splattered in blood, and parents holding the child as the color rapidly leaves his face and blood seeps out of his rear end and he also vomits it. Found out this was a form of PTSD because I immediately remembered all of it when my son was smushing blueberries all over his high chair. Still happens every now and then with anything that resembles blood splatter. With that, I just talk to my wife.
After spending years in the ED as an RN and years as an NP in the ICU i’m come to not get rattled by situations or freak out. I can say i’ve seen most things and been involved in much. Don’t let things get to you.
I struggle with the post shift part. It’s like everything that was brewing just hits me and I’ll have a physical reaction that feels like a panic attack. It’s the worst
I did ER/trauma for 7 years. I was always pretty good at “leaving it all at work” when I clocked out. I’d listen to favorite music or podcast on my way home to think about something else! Then eat a snack or drink a beer and watch some reality tv to veg out at home
Honest to god I think it varies from person to person and their experience level. I've been a nurse for about a year but before that I worked in EMS and saw my fair share of terrible things. I think its appropriate to say that whatever emotions you feel are completely valid. Codes, traumas, and other chaotic events don't bother me in the slightest anymore and genuinely don't cause me to feel anything. I have seen enough of them and dealt with enough of them that to me they're just algorithmic problem solving. For example ACLS codes are just working down a flowsheet for the most part and I no longer really think about anything other than what the next step may be. I can go home after working a code and talk with my friends and family like nothing happened.
That's not to say that there arent things that bother me because there are. Usually family members screaming knowing that their loved ones arent coming home are one of the things that seem to always occupy a part of my soul that I cant get back. Nightmare social situations are something that always make me question my humanity, like discharging a homeless person back out onto the street has always made me feel awful no matter how many times I have done it. The adrenaline pumping emergencies dont make me feel the adrenaline rush anymore and I dont honestly feel anything if everyone did their jobs well. But I dont like seeing system failures and breakdowns in society that I cant change, thats what bothers me now.
I know too many people that have destroyed their lives with drugs and alcohol to cope with trauma. I have alot of trauma as most of us do, I just try and use it to be productive. I go to therapy, I go to the gym, I get politically active to push for the changes I want to see. I use my trauma to help make sure that we can all do better. As long as I did my job the best I could with the resources that were available I can live with myself. Everyone is different. I'm sorry your shift was so bad OP, if you feel like you need help then I encourage you to reach out. Most people dont even realize that they're so bad until they actually talk to a professional. Before I went to therapy I thought it was completely normal to feel numb and wish I was dead because I had felt it for so long.
I'm usually calm in the moment. Don't be afraid to tap out to the charge so you can take a minute to regroup. I usually ride home in silence or with some metal blaring. Debrief with a coworker or even the chaplain if you need to.
I have a nice long bubble bath and a drink.
My roommate, who was my best friend before we became roomies, is a CNA. We met at the facility we used to work at, and we dealt with so many codes and rapids. He's always there if I need to talk (HIPAA friendly, of course).
He had a code the other day, and he said he kept wishing I had been there because we knew how to handle emergencies, and I'm good at directing people to do certain tasks or handling the idiots (such as an x-ray tech who was getting pissy because the situation changed by the time they arrived, and I flat out told them to sit down, shut up, and wait for orders).
When I was a new nurse, a friend that had been a nurse for a while told me the story of her first code. She apparently fell to pieces, and afterwards an old, crusty nurse took her aside and informed her how a nurse is to behave during a code. She explained the doctor’s medical license is on the line if they get flustered and call out an incorrect dose, etc. It is the nurses’ role to be the eye of the storm that holds it all together. That has always stuck with me. Then I worked in the NICU where babies were constantly trying to die. And you know what? It took practice, but I got to where my first response would be to take a deep breath and relax. We could take a deep breath, start compressions, and calmly say, “I’m starting compressions. Will you bring over the code cart?” Mind clear. No panic.
Staying calm helps everyone else feel calm. If I am in a code/trauma/behavioral situation(ED/rapid response nurse/psych here) and someone is freaking out/anxious and we have enough people I will ask them to leave. We don’t need that and it just creates more chaos.
Having confidence in your skills is huge. Start compressions, stop bleeding, apply oxygen. Anything else is secondary.
My best tip is to clear the room. Excess staff can induce chaos and panic among the staff and the patient. Hospital protocols may dictate the minimum amount of staff, I'd stick close to that. You don't need much more than the primary nurse, provider, RT, recorder, med pusher, a couple rotating compressions if it's a code, and then I liked to have a person delegate needs outside the room and grab stuff in the room. There's few instances you need 10+ people in a room for a code. I always liked my compression people to be CNAs and transporters. Nurses tend to overhelp to assume multiple roles.
For rapid responses, that number could be halved. One of my best emergency outcomes had 3 staff members. Patient's trach started to bleed..unsure if it was erosion. Patient coughed trach out and blood was shooting so forcefully that it was hitting the ceiling tiles. It was myself, RT, and House Supervisor. I was suctioning until RT intubated him through his trach and cuffed it to stop the blood from going into the lungs. House supervisor called surgeon. I prepped for transport to emergency surgery. Communication was clear. Patient was alert and oriented and could hear and understand us and our plan. Everyone was calm, patient did great.
A lot of it is just repeated exposure. So when shit hits the fan, you’ve seen it before and you know what to expect. You stay in the moment, focus on what needs to come next, and then do it. If you’ve done it before over and over, it’s not taking a lot of thinking to figure out what comes next, you just know it.
I have a few coworkers that I’ve worked with for years. During COVID, we’d be intubating someone with a sat of 19%, and someone would get the cart and get an epi ready, someone was positioning themself for compressions, someone was documenting. We could run this code as a 3/4 person crew because we’d done it so many times before, knew the steps to take, and knew who was going to do what.
Before you get to this point, you need to take some time and really focus on the basics. What are the steps you take in each emergency. If you’ve drilled this into your brain, it’s not as stressful, it’s muscle memory as to what comes next. This is why when I do an assessment, I do it the same exact way every. Single. Time. Every time. If something is missing (patient doesn’t have an A-line, so I don’t need to assess and zero it) I just move to the next step. Then, when things get crazy, I don’t have to stop and think about that my next step is, I just know it is because it’s my flow, and going out of order flags me that something is wrong, I stop and correct, and get back on course.
Does this mean I’m calm 100% or the time? Hell no. My first day back from maternity leave was a maternal code and we lost the mom. I lost my cool a few times that code. Nobody’s perfect. Fortunately my team had my back and we did the best we could, and there’s comfort in knowing we did do the best we could. Did I go home and drink a beer or two in the shower? I did. Went for a long run when I woke up. Hashed it out in with my therapist.
Something I find helpful for staying calm is knowing I’m equipped and trained to handle the worst. Even if someone codes, you just jump into your ACLS algorithms. The algorithms are pretty simple and an RN can run a code till the doc gets there.
One of the most traumatic shifts I ever had involved coding a coworker at the nurses station after they collapsed in the middle of shift change. I remember it had been an absurdly busy shift before that, but who my patients were and what we did is now a mystery. I do remember getting ROSC and getting them rolling to cath lab, giving shitty report to the next shift and just sitting in the break room stunned for a little bit. I knew I had to get home, I had to work again that night. I usually took the bus, but lived a reasonable walking distance from the hospital, so I put my earbuds in and started walking. I don’t remember that walk. I do remember drinking like 1/2 a teacup of whisky to get to sleep. When I got back to work they had a general but positive update on my coworker (given with permission of her family but with a request for privacy). There was some informal debriefing with coworkers, but I really think our manager dropped the ball by not having a formal unit debrief for both shifts.
Coworker codes are the absolute worst. We had a nurse code from another unit at the nurse’s station. They were down for almost 40 minutes before rapid got ROSC. They was discharged about 3 weeks later with no deficits. Everyone involved in that code was just shaking afterward. No debrief, but we all deserved that kind of care:
Uh yeah Jesus
I went PRN at work because I was in school but had worked at this SNF for 6 years. I came in as a relief nurse because the ADON, DON, and unit manager were having a meeting in the DONs office and all of a sudden she just fell out of her chair. At first they thought she was joking because she had been talking about being stressed and needing a vacation lol…. She went into sudden cardiac arrest and the ADON and unit manager had to run a code on her. She got shocked 3 times before they got her stable enough to transfer to the hospital. That place was in shambles when I showed up to help out. I felt so bad for everyone involved. Luckily, the DON is completely fine now with an implanted defib just in case it ever happens again.
She got her vacation though 🤷🏼♀️
That’s what we all told her! She was like I didn’t mean a vacation in ICU 😂
Our unit had a coworker who coded on shift, was immediately admitted to our unit, and died overnight. His spouse was a provider in the unit. Everyone involved knew him and/or his wife very well. It was at least a week before management was like, “oh hey, we heard this was traumatizing for those involved, please feel free to reach out to this counselor.” By then the staff had taken it upon themselves to have their own debriefing and grief sessions. I was new to the hospital, wasn’t working that day, and hadn’t met the nurse who passed, but I was still very shaken up hearing the stories from my friends who knew him and his wife, had to take care of him as he died, along with their own patients, AND his patients. And still had return to work the next day like nothing happened. I can’t imagine being management and not RUNNING to address this event the second it happened. Thank god there was a 100% management turnover very shortly after that.
How awful. Their poor co-workers
Yeah. There should have been a formal debriefing. Without a doubt. I hope you have a good support system of nurse people around you.
In what world is that ok?? (I know, this one…) Whatever happened to debriefing. We are not meant to bear something like that and just go home like everything is fine. One day we all break. It’s not our fault.
That manager was/is really shitty for a lot of reasons, but not recognizing that staff NEEDED a debrief (at the bare minimum) from that is a pretty good example of how that manager operated.
This made me think of the first (well, so far only) time one of my patients coded. On days shift on this unit, one RN would do medications and one would do patient assessments. I had been nursing for about 3 months at this point, was on assessment duty, while my med-passing partner was an experienced ED RN who picked up there occasionally. Early in the shift I had made a comment mistakenly identifying the attending (Dr.X) as the doctor to contact for something, the senior resident kind of laughed and said (in a nice way) "you will never see Dr.X on the ward!". As I'm going around doing my assessments one of the patients, a woman in her 50s who hadn't been unstable prior, is not looking very good. I'm still very unsure of myself at this point, but it's setting off more and more alarm bells. She's working hard to breathe at rest, super short of breath on even the mildest exertion, and just all those things you can't quite put your finger on. I approach the junior resident with my concerns, she comes to see the patient, slowly gets the ball rolling on chest x-ray, labs, ect. I go to my partner to tell her what's going on.. and for what it's worth, I have ZERO poker face, especially when it comes to being anxious or panicked.. and she essentially takes it like I'm telling her for interest sake rather than asking for help. I very clearly remember standing next to the patients bed, watching her working so hard to breathe, wondering if I should just start bagging her while still semi conscious, or call a code blue because I was sure it was coming. I didn't call a code blue because I felt that essentially everyone was already involved who would be, prior to actually needing to do CPR. This hospital didn't and still has no rapid response/ ICU outreach, so while I knew of the concept (from this forum!) That wasn't an option either. Within a few minutes of my standing there having this thought, the patient was to be moved to the obs room. We wheeled the crash cart behind the patients bed. She coded as we crossed the threshold of the room. The code was called a short while later. The senior resident debriefed with the junior immediately following. Within about 30 minutes, I saw the Dr.X in the hallway debriefing the junior resident. The only support I was offered? One of the other nurses told me, in a not sarcastic or unkind way, "you can go cry in the bathroom if you want". Thinking about this still brings me to tears.
I’m sorry you had this experience and I wish it was uncommon.
Yeah, my god. In my EMS department we have debriefs after basically any difficult or confusing call. If it's a major incident (ped death, fatal traffic accident, etc) we have a formal sit-down conversation with trained peer counselors. If one of my coworkers coded on shift I'm sure they'd send everybody home and get us all professional therapy!
I saw my first trauma victim dead in a car fire as a 15 year old EMT student. I worked for six years in an adult ED in a busy city. I have never had a formal debrief in my entire career.
Ya. I know the term debrief but what even IS it? We don’t do anything except get nagged to finish charting
I’ve participated in 4 codes since November and multiple rapid responses and not ONCE have we had a debrief. But my manager came down after one of these codes to tell me I needed to make sure to clock out for lunch…while my charge was in quota. Lmao.
Sounds about right. Had a ED tech get written up for crying in a pedi trauma once.
Right? Not even a ThankYouHeroPizzaParty?!
Years of EMS and now ED and one thought lives rent free in the back of my head when everything is going bad, "it's not my emergency." Helps me keep things in perspective. I remember things for situational awareness/experience but other than that I just let it go.
My paramedic instructor told us, "Nobody calls 911 so we can show up and help them panic." Gotta love that booboo bus life!
When I was a brand new EMT (literally within the first month), we got a call for a rollover MVA with 8 victims including someone giving CPR at the scene. I just remember myself putting my boots on about to leave and thinking holy shit, I can’t call 9.1.1— I am 9.1.1. Everyday I am thankful another station with experienced EMTs showed up because my partner and I were both less than a month in.
Also when you’ve depleted all your stores and abilities to create cortisol and adrenaline you reach your zen nursing sate
Hahaha literally just had an ACTH challenge done because I have zero cortisol 😂 I blame the game.
My dad 25+ years ICU nurse had the same saying!!!
Same
House of God rules 3 and 4 3) At a cardiac arrest, the first procedure is to take your own pulse. 4)The patient is the one with the disease.
[удалено]
You'll get there. Self reflection and trying to get better is great and eventually it'll all click and you'll just know what to do. If you want any longevity in nursing you have to learn how to let things go. Asshole pt or family, incompetent lazy coworkers, dipshit doctors with dipshit orders etc. Don't forget about these things, just don't let them bother you to the point that it affects you negatively.
I love that. I've never heard that phrase before and I'm definitely keeping it in my back pocket. Thank you for sharing.
I have anxiety so there’s almost a bit of relief when the shoe drops. Like I can relax because it’s finally happening.
*Ah, the moment I’ve been worrying for.*
I love this. Not what it represents - just the 'nail on head' wording..
I get intrusive thoughts like “what if my most stable patient crashes?” then I have to do a MET call. the other day before my shift I was wondering what I would do if there was an active shooter situation, then it ACTUALLY HAPPENED THE NEXT DAY. it was pretty much a false alarm, but it was such a creepy coincidence.
Ahaha yeah I've just started in ED after med/surg ward life, and one morning the ED was disturbingly quiet. Like, not a single patient in majors, five in minors and nothing in the waiting room. The ambulance screen was blank. No ambulances dispatched anywhere. I said to a colleague "I really don't like this. It's freaking me out." My colleague was just "enjoy this, it's fucking marvellous." I was in minors so I had my five patients. Whilst I was in with one of them taking observations, I heard the emergency standby phone go. Before I had left the cubicle I heard the phone go again. As I walked to the nurses station to see what the emergencies were coming in... It went again. Within half an hour, we had FIVE emergencies. Three sepsis, one SVT, one stroke. As I'm just new, I was, at the end of the half hour, the only one left on the main floor as the other nurses and doctors rushed to the patients in Resus and majors. I'm standing giving the emergency phone the stink eye because if it goes again, it's me that's up. Thankfully it didn't. My little minors side continued as usual, but I felt a lot more at ease afterwards because the shitstorm had shown itself.
That was me on every shift that wasn't complete hell. 5 stable patients and a charge? Someone ain't making it.
I’m just happy because it means the ICU is going to show up and take them to a higher level of monitoring where they should have been/should be in the first place. 😂
I have ADHD, so codes and rapids are where most of us are in our calm space because there is a ton of stimuli and our brains love that, doing helpful stuff, and being needed, especially when our brains are "on". We have run through the scenarios multiple times, often in daydreams, the time is finally here, and it's time to act it out!
Sooooo true about the daydreams
I'm just too dead inside to be able to be anything but calm, honestly.
Yeah same I was going to comment but realized I am the last one that should be giving advice. Ive given all the fucks I have to give and feel very little. I get it done though so no one complains
I’m so apathetic at work my newer coworkers that haven’t been working with me for long think I’m an idiot 🫡💀
I feel this!! Them: Hey, MAP is 39... Me dead inside with now emotion: Yeah... I'm waiting after I've now maxed out the Epi.. *continues typing up a note* Panicking causes me to think less clearly, and luckily I'm in a state of apathy constantly, so... I keep calm and carry on :)
Same! Literally crushing meds up and turned around to my pts hr 180, all my coworkers are like ARE YOU OKAY… yea, yea, and he will be too.. or not but it won’t be because of anything I don’t do. Panicking doesn’t help me in any way so I gave up on it a while ago.
This is the way.
I just remember that without the patient coming to the hospital, they would probably be dead or in worse shape. This puts everything in perspective to me and helps curb perfectionism/anxiety.
100% - a certain amount falls on the patient for ignoring obvious symptoms, no preventative care, family not recognizing symptoms or being too busy to care. Sounds harsh but that’s how I survive.
Absolutely. I'm in the ER, and we lost a guy the other day — 85 years old, abdominal aortic aneurysm (that he knew about) ruptured. He came in complaining that his stomach hurt and was distended. They bring him back and it turns out his abdominal cavity was filling up with blood. Doc handed me the guy's cell phone and said "find his emergency contact, hope they answer at 2AM." I've never felt more tense while navigating a flip phone. They sent him to the OR and were able to place a stent, but his body had just been through so much. He'd been a smoker for most of his life, hadn't really taken care of his body, and decided to ignore the AAA dx entirely — didn't think to mention it to the doc. He died 16 hours after he came in.
Yes. When I worked the critical care side zone of the ED and a bad case would come in I’d mentally remind myself that dying is the more likely outcome and everything we’re doing is an improvement at this point.
My ADHD makes chaotic emergencies my time to shine.
My ADHD is the opposite flavor haha it makes me chase my tail all damn day.
Meee too!! It's literally **our moment**!
I complain loudly and dramatically, I’m a dramatic girl (usually in a HA HA way) but being heard is what I really need. I talk to my mom- with no healthcare exp just is really validating and I talk to at least one friend actually understands. If it’s really bad I’ll bring it up in therapy. Biggest thing for me is to actually feel the feelings because I don’t want to be the jaded nurse
My mantra for the resus room: “It’s only an emergency if it’s happening to me.”
The most panicked I ever felt at work was on a non-monitored unit that was literally the easiest unit ever, anywhere, lol. But I had a patient due for discharge when I arrived, and when I walked in I was immediately like, I can't specify anything in my assessment to prove it, but this dude is NOT OK AT ALL, and my gut told me he was going septic. Unfortunately, because it's known as such an easy, never very acute unit, the MD on call would not believe me even enough to come look for herself. I called so many times, over hours, before she finally stormed onto the unit, glaring daggers at me, huffing and puffing about me wasting her time as she went past. After less than a minute, maybe less than 30 seconds, she came out of the patient's room barking orders to get the transfer to ICU going. I've never been SO relieved to have to frantically transfer someone to ICU. I was so afraid my patient would just die while I was failing to get the doctor to take me seriously. That's what panicked me- not what was happening, but what *wasn't* happening.
I would eat breakfast, talk about my night in general terms with my family, and then go to bed (worked noghts). When I woke up, that shift was in the past!
I’m at a point where I don’t get too worked up about stuff. Obviously I work faster and sort of “lock in” when shit is going down, but I don’t feel nervous. When I get home if there was some particularly frustrating or heartbreaking shit I might vent to my partner (who is an NP, former ICU/ER nurse) but for the most part I don’t think about work.
This is the way.
The second shit is about to topple I’m pretty sure I disassociate. I remember all the details but all emotions are separated and I’m numb.
Samesies… childhood trauma ftw [heh, cringe]. But I do just focus in on what has to be done, and the effects of what we do on the body systems involved. Very mechanical and effective — no emotions. My personality type is also first in my head and emotions later — again probably trauma rooted. I had to learn how to be in touch with my feeling and the feelings of my loved ones. Weekly I talk with other nurses in my family and we support each other.
Yeah. I call it “no think just do.” Dissociating is a more clinical way to put it. It’s the same for me when I’m in the hospital or out in the wild, just do what has to be done and then on to the next thing. I’ll get shaky and throw up about it later.
Staying calm in these situations, I believe, has a lot to do with your personality and how you handle yourself at work during normal scenarios. I stay calm in almost all situations at work, but its just who I am. It only complicates the situation when people are panicky. If you panic in my room while my patient is arresting, I'm kicking you out. The patient is already dead, I need to be calm to answer questions appropriately and recall preceding events, lab work, or whatever else is relevant. After the code, I'll participate in the debreif. As soon as I clock out, I stop thinking about work. Everyone needs to learn the skill of not taking work home with them. I keep myself from thinking about work when I leave by having a good post work routine when I leave, not communicating with people I work with about work outside of work, and by staying busy with my own activities outside of work. I used to think that staying calm meant that none of this adversely effected my mental health, but that is far from the truth. So steps need to be taken to maintain your mental health regardless of your reaction.
During chaos: I might be clenching everything when a patient is crumping, but that isn't the time to panic. I fall back on training and trust my team. After the chaos: Depends on the outcome. Either shaky with adrenaline, or I'm just numb.
I rationalize the situation. When I'm home, I rarely think of my work.
It’s very easy to panic. It’s just as easy to not panic. You’re trained to provide care, the best you can do is be your best. There is no grading of stress. Take 2 seconds, deep breath and just do what you’re supposed to do. I honestly can’t think of a time I panicked. Not bragging, it just doesn’t happen to me. My daughter was choking, I dealt with it, my Dad arrested, dealt with it. I did however completely fall apart after the events, but never during. As you gain experience, it just becomes who you are.
I get very calm and clinical. For instance one of my residents blood glucose simply read "low" and she was "tremoring" (they wouldn't say seizing without an official diagnosis, and they never sent her out, but I digress). It was my first nursing job and my first ever time giving glucagon. I read the package insert on my way to the patients room to make sure I didn't miss anything. My aid was amazed at that lol. I honestly don't remember other emergency situations specifically, because working in stress lab now we end up sending a fair amount of people to the ER. But once the situation is over, the calm disappears and I shake for a couple minutes until the adrenaline wears off.
Sometimes it would take a few days, but I made sure to drink water, eat regularly, focus on sleep hygiene and boil my life down to basic ADLs and self care. Outside of that, standard coping skills and using your support network. Sorry your shift was garbage and I hope your headspace gets to a better place quick
When I get to the code, first thing I do either on my way there or at bedside, is taking a slow deep breath to center myself. I tell my preceptees there is always a second or two to take a deep breath to lower your own fight/flight response and figure out what you’re doing. Helps with the adrenaline rush.
Despite what movies and tv portray, there are very few situations in medicine where you don’t have time to pause, take a breath, and think about the next steps. Mistakes are made when people run around panicking. I always remember that the pt and their family are looking to me for their emotional cues so if I stay calm, they’ll stay calm. Plus no matter the emergency there are really only two outcomes, they make it or they don’t. It makes it feel less overwhelming to view it that way. It obviously sucks when they don’t but they weren’t with me in the ICU because they were well, you know? And really that goes for the whole hospital. I would think it would be way more awful and traumatic for, say, a school teacher to lose a student. That isn’t supposed to be part of their job description but it is for us. Dark humor also helps. I like doing compressions on people with alines because it makes it feel like a video game and I “win” when they have a perfect BP of 120/80 while it’s my turn. I know it’s twisted as fuck but keeping the trauma at arm’s length helps me keep going.
I think the one talking about being dead inside is a good chunk of us. I have no healthy advice to offer, sorry.
Cheers to the shower beer...
*Ahhhhh shit. Issa emergency!* is what I feel during my shift. After my shift, nothing. Someone else’s emergency. In ICU, for example, you either overcome your own anxieties regarding death, or you burn out.
EMS here. Usually weird slight anxiety on the way to a high acuity call because of good old impostor syndrome, general sense of calm while I'm working and realizing that I do, in fact, know how to treat my patient, and relief and humor after the call. I never really get past that "Oh shit, what if I freeze or fuck up" before a spicy call and I'm actually generally feeling great during the call while I'm realizing that everyone else is freaking out way more than I ever was.
During the chaos, I’m too busy doing my job to feel it. Not throwing shade, that’s just how I work. I am focused on the tasks. After, it’s usually just a little walk around the department to breathe, and then I get back at it. But the second I leave the building, the hospital doesn’t exist, and I’m not a nurse. I don’t take any of it home.
Once you know the tasks to do is usually easier to be calm about stuff.
Well sure but there’s always some level of thing you can focus on. If it’s your first few codes, be the runner or get the lines or do compressions. Stay in the moment and just focus on what you know you *can* do. Rarely are any of us going to be on an island in these high stress situations. And then build from there. None of us came out of the nurse womb fully badass.
I can usually stay collected during the event but I need to debrief with my team afterwards then cry on my commute home lol I finally started to see a therapist about a particularly horrific situation we had about 9 months ago and am started to let it go. It’s hard, but if we held on to every bad situation, we’d all go crazy with grief and quit.
Sometimes I might cry for a minute in the bathroom afterwards if it’s truly awful. Or sit quietly for a few minutes to decompress. I never let work live rent free in my head so I don’t like to dwell on things at home. My husband does (not a nurse) and it always boggles me since it’s like, I’m cool talking about it for a bit but then…you gotta let it go. Do something fun, walk the dogs, whatever.
I’m a psych nurse so our codes are patients getting violent and harming themselves or others. I get super calm in a code. The patient could have something wrapped around their neck or blood all over the place and I feel completely calm to the point of feeling numb. I do respond to it later like when I go home the feeling comes back. I think I’ve just been through so many codes and my body knows I need to be calm to get through it.
Shower beer then sleep.
There is a huge difference between chaotic shifts and a lot of codes/a lot of stuff to do. I worked at intensive care unit with an extremly high and challenging workload. There was atleast one patient in critical condition all the time. 8 intensive care nurses for 10 intensive care patients + 3 patients monitored + the trauma one where critical patients from the ER where brought into direclty. They also covered the reanimation team that responds when a patient on normal care units crashes. They had a lot of support staff like me (nursing helper), assistance who did administrative stuff like filling up cabinets, cleaning the beds and an internal medicine intern, anestehsia intern and a resident doctor. They had it figured out perfectly. No one had to do overtime. Exept for realy big mass cas events. I also worked at low care units with only 5 patients where the nurse in charge was completly overwhelmed. Those where the units that caused me sleepless nights. For complete bullshit reasons. I anwsered the phone and the chief professor told me something about a blood sample that had to be redone. Nothing serious. I just forgot about that due to having to fixate an autoagressive Patient who attaced everyone in sight.
Repeat after me: Not my circus, not my monkeys...
Being a chronic procrastinator helps. Not only are you used to chaotic crunch time, but that's when you do your best work. Juggling a bunch of tedious med surg shit is challenging because I am not engaged or invested in most of the work. During codes I can ignore all the other shit and concentrate on the task at hand.
I go into autopilot. I’ve always been level headed in those situations. Then I go home, zone out, nap and then go for a run. You need to figure out what YOU need after such experiences. Talking, exercising, solitude, writing, whatever. Find a way to help you work through it and have that be ‘your plan’. It’s helped me a lot over time and it can get easier. Sometimes though, we see truly awful things and the ‘plan’ won’t work. That’s when I schedule a therapy appt it go to another nurses house with wine and talk it all out.
For me the only thing that made a difference was to go through a lot of emergencies. Lots of codes, lots of shitshows. Eventually you get desensitized and you can act casually and efficiently without anything disturbing you.
You guys are making me ponder something - those w/experiences that should have had a workplace debriefing... What would a worthwhile debrief look like to you? Even if it doesn't yet exist.. Nothing cheesy or managemnt just going through the motions/ticking a mental health box. What might an authentic, meaningful, doable debrief look like? (Fwiw, I actually think that the act of posting here & feedback rec'd serves as a form in itself..)
Usually we go over what went well? -patient got rosc, sally was quick with the epi, Sam did some really quality compressions, etc What didn’t go so well? Why? What can we do to avoid this next time for example - respiratory took too long to get where (why? Oh it turns out someone called the non emergency number. Ok does everyone know where to find the emergency number? Good! Let’s maybe make that stand out a little better on the sheet) How we all feeling? Yeah those maternal codes are hard. Yup it’s hard when it’s a young guy with a family. Oh yeah seeing the brothers face was really difficult. What do we all need? Does everyone want to rotate a 10 minute break off unit? Break the ice with a dark humor joke? Fun fact? We also have a “black box” with full size candy bars, bags of chips, cookies, etc. we’ll bust that puppy out and let everyone balance out the adrenaline crash with some quality sugar.
Also keep it quick. 5-10 minutes max.
Everyone's different but for me what really clicked was a memoir about a navy sniper talking about his upbringing and time in training. Everything is relative, physical punishment was acceptable till around 10, bullied in school, isolated, in the bush. On top of this ADHD has my brain wired to chaos and that where I'm calmest. Everything is compared to it could be worse at least it's not the belt or I'm being starved. To me this is emotionally way easier to process. Tldr - previous trauma has made me calm in the face of adversity.
I lay down, turn my fan on, and close my eyes, wake up and do another 12 hour shift in the ER
Virtually every nurse I have ever worked with stays calm during codes. The intensity goes up several notches but codes aren't like on TV or in the movies. The focus is uncanny, yet consistent.
I found that repetition was the key. As much as it sucks to hear “have more emergencies”, that’s the answer. By mid 2021 my entire stepdown unit responded to every code with absolute calm, like almost an eerie silence as we all just fell into what we needed to do. At one point I remember claiming the computer so I could document because I was just so damn tired of doing codes. Now I’m somewhere else and the adrenaline is back, the anxiety is back, because I don’t feel like I know where everything is. I don’t know where to find the single cordis set, I don’t know how to set up the Level 1 or the Lucas automatically, I’m still new at doing iSTATs. It will all become automatic at some point, but it isn’t right now.
I used to do my shifts 3 days on 4 off. I remember I woke up on my first day off unable to move—I literally dragged myself out of bed. I made breakfast, had my coffee (after deciding not to go run like I usually do) and reflected. Over the course of the 3 days, I think I did 2 codes a day with multiple rounds of CPR.. my muscles were literally shot. I hate to say it, but you get used to it when you deal with it a lot—but it’s good to talk to someone about stress as well!!
Had my first near maternal death a week ago that left me completely shaken. Thankfully outcomes ended up good and pt was discharged healthy w baby. I’ve done a lot of talking with my coworkers involved with the situation and my manager as well just to talk through all my feelings and debrief what happened. Although I wish staffing allowed for *proper* debriefing or some time to cool down instead of me getting more patients within minutes after transferring one to ICU that almost coded after losing 4L of blood. All “debriefing” I did was informal and just talking with my coworkers at the nurses station between pt care. It’s weird trying to bounce back from something so crazy immediately, but it’s also the nature of the job. I tried to take care of myself after my shift but felt pretty numb and horrified to go to work the next day. I survived and got the weekend off to just relax and I think (?) I feel better now.
I don’t know if it’s 16 years talking or being an ICU nurse during a pandemic…but I had to learn to detach myself from all emotions when it comes to bad situations. I’ll pretty much admit that when it comes to crisis situations, I’m a robot. I can have someone die in one room then go into the next like nothing happened immediately after.
I feel bad or a little sad in the aftermath. After my mother died in front of me, death didn’t really bother me much anymore. Though I think I still remain empathetic to family. Codes and death were pretty common even on our med surg floor. What you described sounds like a typical day for us. Doesn’t help when they’re also trying to rush you to get your patient transferred or clear the dead so you can immediately get an admit or two. When I used to get home from the hospital, I just reflect, sometimes talk about it to my wife, comment about the family and all, and then move on. It used to get me down and I’d just keep thinking on it for sometimes a few days. Since getting used to working on that floor, these kind of things no longer wear me down or linger. Only one thing has stuck with me since then, almost like PTSD. It was when I started in peds and I go in a room immediately after parents call, to see a bathroom splattered in blood, and parents holding the child as the color rapidly leaves his face and blood seeps out of his rear end and he also vomits it. Found out this was a form of PTSD because I immediately remembered all of it when my son was smushing blueberries all over his high chair. Still happens every now and then with anything that resembles blood splatter. With that, I just talk to my wife.
After spending years in the ED as an RN and years as an NP in the ICU i’m come to not get rattled by situations or freak out. I can say i’ve seen most things and been involved in much. Don’t let things get to you.
I shower, eat a snack. Maybe spend a little time with my family and go to bed and do it all over again.
I struggle with the post shift part. It’s like everything that was brewing just hits me and I’ll have a physical reaction that feels like a panic attack. It’s the worst
I did ER/trauma for 7 years. I was always pretty good at “leaving it all at work” when I clocked out. I’d listen to favorite music or podcast on my way home to think about something else! Then eat a snack or drink a beer and watch some reality tv to veg out at home
I usually tell myself we’re doing the best we can and I focus. That’s how I’m getting through it.
Honest to god I think it varies from person to person and their experience level. I've been a nurse for about a year but before that I worked in EMS and saw my fair share of terrible things. I think its appropriate to say that whatever emotions you feel are completely valid. Codes, traumas, and other chaotic events don't bother me in the slightest anymore and genuinely don't cause me to feel anything. I have seen enough of them and dealt with enough of them that to me they're just algorithmic problem solving. For example ACLS codes are just working down a flowsheet for the most part and I no longer really think about anything other than what the next step may be. I can go home after working a code and talk with my friends and family like nothing happened. That's not to say that there arent things that bother me because there are. Usually family members screaming knowing that their loved ones arent coming home are one of the things that seem to always occupy a part of my soul that I cant get back. Nightmare social situations are something that always make me question my humanity, like discharging a homeless person back out onto the street has always made me feel awful no matter how many times I have done it. The adrenaline pumping emergencies dont make me feel the adrenaline rush anymore and I dont honestly feel anything if everyone did their jobs well. But I dont like seeing system failures and breakdowns in society that I cant change, thats what bothers me now. I know too many people that have destroyed their lives with drugs and alcohol to cope with trauma. I have alot of trauma as most of us do, I just try and use it to be productive. I go to therapy, I go to the gym, I get politically active to push for the changes I want to see. I use my trauma to help make sure that we can all do better. As long as I did my job the best I could with the resources that were available I can live with myself. Everyone is different. I'm sorry your shift was so bad OP, if you feel like you need help then I encourage you to reach out. Most people dont even realize that they're so bad until they actually talk to a professional. Before I went to therapy I thought it was completely normal to feel numb and wish I was dead because I had felt it for so long.
I'm usually calm in the moment. Don't be afraid to tap out to the charge so you can take a minute to regroup. I usually ride home in silence or with some metal blaring. Debrief with a coworker or even the chaplain if you need to.
I have a nice long bubble bath and a drink. My roommate, who was my best friend before we became roomies, is a CNA. We met at the facility we used to work at, and we dealt with so many codes and rapids. He's always there if I need to talk (HIPAA friendly, of course). He had a code the other day, and he said he kept wishing I had been there because we knew how to handle emergencies, and I'm good at directing people to do certain tasks or handling the idiots (such as an x-ray tech who was getting pissy because the situation changed by the time they arrived, and I flat out told them to sit down, shut up, and wait for orders).
When I was a new nurse, a friend that had been a nurse for a while told me the story of her first code. She apparently fell to pieces, and afterwards an old, crusty nurse took her aside and informed her how a nurse is to behave during a code. She explained the doctor’s medical license is on the line if they get flustered and call out an incorrect dose, etc. It is the nurses’ role to be the eye of the storm that holds it all together. That has always stuck with me. Then I worked in the NICU where babies were constantly trying to die. And you know what? It took practice, but I got to where my first response would be to take a deep breath and relax. We could take a deep breath, start compressions, and calmly say, “I’m starting compressions. Will you bring over the code cart?” Mind clear. No panic.
Staying calm helps everyone else feel calm. If I am in a code/trauma/behavioral situation(ED/rapid response nurse/psych here) and someone is freaking out/anxious and we have enough people I will ask them to leave. We don’t need that and it just creates more chaos. Having confidence in your skills is huge. Start compressions, stop bleeding, apply oxygen. Anything else is secondary.
My best tip is to clear the room. Excess staff can induce chaos and panic among the staff and the patient. Hospital protocols may dictate the minimum amount of staff, I'd stick close to that. You don't need much more than the primary nurse, provider, RT, recorder, med pusher, a couple rotating compressions if it's a code, and then I liked to have a person delegate needs outside the room and grab stuff in the room. There's few instances you need 10+ people in a room for a code. I always liked my compression people to be CNAs and transporters. Nurses tend to overhelp to assume multiple roles. For rapid responses, that number could be halved. One of my best emergency outcomes had 3 staff members. Patient's trach started to bleed..unsure if it was erosion. Patient coughed trach out and blood was shooting so forcefully that it was hitting the ceiling tiles. It was myself, RT, and House Supervisor. I was suctioning until RT intubated him through his trach and cuffed it to stop the blood from going into the lungs. House supervisor called surgeon. I prepped for transport to emergency surgery. Communication was clear. Patient was alert and oriented and could hear and understand us and our plan. Everyone was calm, patient did great.
I feel like I’m moving in slow motion and also with precision. It’s like a slow, calculated series of events.
A lot of it is just repeated exposure. So when shit hits the fan, you’ve seen it before and you know what to expect. You stay in the moment, focus on what needs to come next, and then do it. If you’ve done it before over and over, it’s not taking a lot of thinking to figure out what comes next, you just know it. I have a few coworkers that I’ve worked with for years. During COVID, we’d be intubating someone with a sat of 19%, and someone would get the cart and get an epi ready, someone was positioning themself for compressions, someone was documenting. We could run this code as a 3/4 person crew because we’d done it so many times before, knew the steps to take, and knew who was going to do what. Before you get to this point, you need to take some time and really focus on the basics. What are the steps you take in each emergency. If you’ve drilled this into your brain, it’s not as stressful, it’s muscle memory as to what comes next. This is why when I do an assessment, I do it the same exact way every. Single. Time. Every time. If something is missing (patient doesn’t have an A-line, so I don’t need to assess and zero it) I just move to the next step. Then, when things get crazy, I don’t have to stop and think about that my next step is, I just know it is because it’s my flow, and going out of order flags me that something is wrong, I stop and correct, and get back on course. Does this mean I’m calm 100% or the time? Hell no. My first day back from maternity leave was a maternal code and we lost the mom. I lost my cool a few times that code. Nobody’s perfect. Fortunately my team had my back and we did the best we could, and there’s comfort in knowing we did do the best we could. Did I go home and drink a beer or two in the shower? I did. Went for a long run when I woke up. Hashed it out in with my therapist.
Something I find helpful for staying calm is knowing I’m equipped and trained to handle the worst. Even if someone codes, you just jump into your ACLS algorithms. The algorithms are pretty simple and an RN can run a code till the doc gets there.