Tuesday, December 13, 2011

"We're In a Code"

Go ahead and turn your caps lock on now, butthurt commenters. Here we go.

So, as I may have mentioned before, last night sucked. Hard. I think we had about 4 intubations and 2 codes in the first 2 and half hours in addition to a bunch of other train wrecks and ICU holds that were already down in the ER at this point. At some point in the midst of all the madness, we hear them call a code blue to one side of our ICU (it's split into 2 big hallways) and think little of it. Even procedure whore doc, who usually is calling upstairs to see if they need intubation before the operator is even done announcing the code, payed little mind, as he's already intubated half the patients in the ER at this point and was over it. About half an hour later, they assign me an ICU bed on the hallway where the code isn't happening. I get my stuff together and call up there, and some chick answers the phone and is like, "Um, did you NOT hear the operator? We're in a code right now. Yeah. I think your report's gonna have to wait for a little while." Generally trying to be understanding, I ignore the fact that this woman is talking to me in the same way one would speak to a child who is interrupting the grown ups talking and say, "Oh, I'm sorry, I thought that was the other hallway." I swear I can hear her roll her eyes over the phone as she responds, "Well, up here we all come help", after which the B hangs up on me. Oh hell naw. Let me break this down for you, girl.
One, is it really necessary to act like that? If you'd just been like, "hey, we're all in this code, can the nurse call you back", this would not be an issue and I wouldn't have to make fun of you anonymously over the internet. But now I do. You brought this upon yourself. But seriously. I'm so sorry, I didn't realize the important ICU nurses were still in a code, which I wouldn't understand, because we don't do anything down here besides sew up boo-boos. Let me just get back to handing out ice packs and Norco until the real nurses can call me back and bestow upon me the honor of taking report. Meehh.

But the real point of the post is, how many of you does it take to code a patient? I'm gonna drop a hot opinion on y'all right now and say if it's more than 5, you're probably doing it wrong. I apply that rule to us, too. Okay, if you're coding a patient you need a nurse to record what's happening (1), a nurse to push meds (2) two to alternate between compressions and code gopher (3 and 4) and I'll throw a 5th in there to do other procedures or whatever or to bag if RT isn't there (which they are). Really four is enough, and we've coded patients many a time with three with no problem. If we're really in a bind, I've had days where it's me, super medic and a doctor where I push drugs and record and super medic and the doctor switched off compressions while the doctor ran the code. It's not ideal, but you know what? I would rather have that any day than 10 people in the room. Why? Because if there are 10 people in there, half of them are just standing around anxiously getting in everyone's way, and that is the most annoying shit in the world. If you are standing around in a code, your presence alone is not helping. You are making it worse because you are limiting flow in and out of the room, and you are sucking up everyone's oxygen and making it hotter in there. Get the F out.
If I am the recording nurse, I will actually tell people to get the hell out. If I am helping and a bunch of people come in, I will switch with someone and go take care of my teammates' patients while they're in the code while announcing loudly on the way out that the room is at capacity and the fire marshall is going to come and write us a ticket. In the ICU, I would think this is probably even more true because you often already have lines and an airway established. So you're doing compressions, pushing drugs, and recording . It shouldn't take that many of you. Plus the house supervisor, the chaplain, and everyone else and their mama is up there in your business once that shit gets called overhead. To quote my ICU buddy nurse XY, "It's an ICU room, not a clown car". Leave.
My second point is, that shit must be nice. It would be rad if we were coding one patient down here and if EMS showed up with another super sick patient we could be like, "Nuh-uh! We're in a code! You keep that out in the ambulance bay until we're done! What's wrong with you?" But it doesn't work that way. Sometimes we just have to bag with one hand and do compressions with the other and push drugs with one foot while hoping we remember all this crap, because every patient down here is crashing at the same time. It happens, and I don't feel sorry for myself about it because this is what I signed up for. But do I feel sorry for you when you are asked to step out of a code 15 people are standing around in to take report from the mean, ugly ER nurse so I can fill my room with the next code coming in down here? Nope! That's the way nursing goes. Dry your tears with your fancy cellulose dressings and pull up your disposable one use big girl panties that we don't stock down here and deal with it.

20 comments:

  1. She was so integral to the handling of the code that she stopped to answer the phone...

    Love the line about big girl panties ;-)

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  2. Whats even funnier is to call med surg and THEY can't take report because somebody elses patient is coding 50 yards down the hall. The code team handles the code for them for cripes sake.

    By the way, our code team also goes to the ICU so that should free up a whole lot of people.

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  3. Peoples response to codes never ceases to amaze me. I had a patient code once and after working on the patient awhile someone finally took a rough head count. There were 11 RT's in the room, a couple of residents, 2 house supervisors and who knows how many nurses. Then a couple months back we had a baby code on our floor. Seriously a unit clerk that floats to some of the floors came running down to see if we needed "help". Yeah right. Just a ghoul wanting to looky loo.

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  4. A to the MEN, sister.

    Also, on the 'more than five' principle, I couldn't agree more. I would rather run a nice, quiet code with four people than a big hot screaming mess with 47 (and 11 RTs...what?!) any time of the day.

    Hang in there. You're a kickass nurse - don't burn out, sister.

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  5. You ht the nail right on the head!! This is the total truth. I work in an ER and after the ICU has a code.....not only can they not take report or get a new patient on the floor during the code, they can't take a new patient/report for approximately 1 hour after that said code!! Its ridiculous. Thats like me not taking another sick patient when they walk through the door. Same thing goes with tele floors or gmf beds....The other night I had a patient who was hypertensive and the floor pitched a fit and called the house supervisor because of the patient's BP and said they couldn't take the patient. This I don't understand at all.....You are a nurse just like me...How come you can't handle HTN??? Ugh the stupid excuses I hear sometimes.

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  6. "We won't take report, blah blah, invalid excuse, excuse, it'll be numerous minutes."

    *Calls nursing supervisor*

    Two minutes later: "Okay, I'm ready to take report now."

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  7. AMEN!!! How many times do you get the attitude like this from a med/surg floor because they have to give meds...give me a break! I would like to say that you could have handled that in such an ugly way and I for one am glad you did that on here (only so I can read it, thanks)

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  8. The last code I was at started with someone sending an STNA throughout the building to gather ALL nurses...WTF did we need ALL nurses for?? Believe it or not, that was the facility's procedure. Way to go...I am a new follower! Love your post!

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  9. One of the million reasons I could not do your job is that I would likely have found that person and asked if they wanted to have that conversation face to face, now that said code was finished.

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  10. @battynurse- pedi codes are the WORST. I have trouble dealing anyway, so I won't go in there unless it's my pt because there's always a million people in there. And a unit clerk? Seriously? Wtf are you going to do?
    @Kat- that's possibly the worst procedure ever. Most certainly established by someone who had never been in a code ever. And glad to have you!
    @ Tigerama- Dude. I really was like that when I started. I learned to just ride with it after I got the house sup called on me a few too many times for being too sassy. I actually had a med surg charge nurse email my manager because I rolled my eyes at her. Now I just take comfort in the fact that these bitches don't work on my floor and I don't have to see them every day.

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  12. oops (to the above delete).

    The units I worked on - we didn't even get oral report with a transfer up, the patient was brought in and stuck in the room by a porter or nurse...the ER charting on the front of the clipboard - handed over to whomever came in to help.

    That was good enough for me...if there's an empty bed - you assume it will get filled...code or no code.......any oral report was a repeat of exactly what I could read off the chart and I figure I can read like anyone else.


    Half the time we didn't even know a patient was coming to the floor. You get used to it. I was certainly ok with it.

    Some nurses are way too..... spoiled.....

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  13. Re your response to Tigerama: was fired for something like that. Being 60 I'm done with it anyway. Good luck to.the new kids on the bkock. With love the dinosaur.

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  14. "...and I wouldn't have to make fun of you anonymously over the internet. But now I do."

    I love you.

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  15. I was new to a hospital one day when we had a code in my ICU. Nobody would leave the room. Except me. I was new there but not new enough to think I needed to be in the room of every code. An older nurse, who was actually involved and helping, stood up, looked around vaguely, and hit the floor. She had health problems, so there was a collective "Oh shit she stroked" response. And then we began a SECOND code, on the floor next to the first one. Standing code people trying not to step on floor code people... Nurse was OK.

    In another ICU, we had 5 nurses, 9 critical patients, 2 simultaneous codes going on. 2 RNs per code, 1 watching the other 7 sick patients.. No aids, medics or non-code team docs running around. I think we had a useless nursing sup making noise without helping anything... It was tight, but at least there it wasn't possible to have a clown car room. ER got mad that we didn't answer the phone and rolled an admit up (needed respiratory isolation- 1 RN watching 7 ICU patients just can not do it) without warning. Their reason for showing up without giving report? "The family was impatient- we faxed a note that we were coming." Yeah well take them back down to the ER. No can do right now. I thought the ER nurse was going to have a stroke too. That patient came up to us maybe 90 minutes later- had been tubed in the meantime. And no, they had NOT faxed a note- not that it mattered, we didn't do fax report anyway. I work both sides of the "take the patient!" fight, but that was unsafe and ridiculous.

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  16. LOL! Love the clown car comment. I work in long term acute care. Had a code earlier this year; the ER doc come up as per policy, but she just stood in the doorway and called the code. (Course, it was the second time that shift that the patient had coded)

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  17. I think I talked to that same nurse last weekend.

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  18. seriously - it's a code, not a clown car. FOR REALS. But!! I will say this - admitting a patient to the unit or the floor, particularly if they are sick/unstable is a VERY time consuming process. If you have other patients, you better hope they are rock solid for at least 60 minutes while you run around doing your admission BS and carrying out any new orders/orders ER RN's didn't have time to complete.

    Dodging report to rubberneck in a code is NOT OK. Questioning whether or not a pt is being appropriately admitted to your floor to make sure they will be getting the appropriate attention from the nursing staff is OK in my book. If you already work in a unit capable of providing the appropriate monitoring for said 200's/100's patient, then get your ass in gear and prep that gtt and set up that pump and get ready to do your fucking job.

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  19. I work in a Surg ICU unit in a big, fancy hospital. During a code we had a resident accidentally pull out a drain, panic, and pass out next to the coding patient. That was really hard to remain professional and not bust out laughing at. Crap-even walk away from!

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  20. I thought the same thing as you "why are there that many people in the code" We had one on the trauma unit when I was working, and by the time I got there (down the hall, about 40 steps) there was about 20 people there. I just turned around and said loudly "well, I'm not needed here, I'm going to go help other people" I watched patients, did charge nurse stuff (she was busy with the code). And you know what? I got a thank you card from the charge nurse for that.

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