4 Emergency Tips All Nurses Should Know
Emergency situations in the hospital are always going to be a part of a nurses life at work. They can come in many different forms, all the way from a person choking in the hospital cafeteria to a level one trauma in the emergency room. Sure some areas such as critical care and the emergency room will experience more of these types of events than others, but regardless of what area you choose to work, there are 4 important things that every nurse should know.
Know Your Role
I still remember my first experience in a code. I was in my last semester of nursing school, and was working as a nurse tech in Medical ICU to gain experience before I graduated. One day, towards the end of my shift, I was asked by my charge nurse if I would like to stick around and watch one of the nurses remove a nasogastric tube. I said sure, and while the nurse was removing it the patient went asystole. Guess what, I just found myself in my very first code, and as you can imagine the mood in the room changed quickly. I was wanting to help out, but I wasn’t sure what my role should be. I wasn’t qualified to give medications, run the code, or make any big decisions, so I just stood there thinking about what can I do to help. That’s when I remembered, “Hey I am CPR certified”. After the first round of CPR was completed, I asked one of the nurses if I could take over. She said that would be fine, and I got to help out in my very first code. I quickly realized that I had a long way to go before fulfilling my dream of getting into a top CRNA school and becoming a nurse anesthetist. However, it was a journey that I was willing to take, so I took it one step at a time.
Every emergency situation requires a teamwork approach, and that is why it’s important for everyone on the team to know exactly what their responsibilities are. Each of us have our own strong suits, and we will naturally migrate to what we feel comfortable at. With that said, there are a few nursing roles that every emergency situation requires. Attending CRNA school will help train and prepare you for the roles that require more of a leadership action. The “recorder” is someone who documents everything that is being done, and creates an accurate flow of events that can be charted later. This includes important times, staff involved, medications given, interventions performed, etc. In my opinion this is one of the most important roles on the team. Next, we have the team leader who is usually the person “running” the code. They will adhere to ACLS protocols and make sure the patient’s problem is diagnosed properly, correct medications are given, and decide between any interventions that may be required. If it is your patient that is needing help, then you need to be available to answer questions. You are the person who is most familiar with the patient’s history, diagnosis, current medications, labs, etc. It probably isn’t a great idea for you to be doing CPR and get tied up doing something that prevents you from answering questions. These are just a few roles for you to consider when you find yourself in an emergency situation. It is important to look at your strengths and weakness, and then decide where you will be able to help out the most.
Take Control of Your Environment
When I worked in ICU I was was exposed to a lot of codes. This actually helped me a gain admission into a top CRNA School, because nurse anesthesia programs want students who are calm under pressure. I quickly learned that the biggest factor on whether or not a code went smoothly depended on the vibe that the person running the code gave off. When you are in these types of situations you’ll notice something interesting. The overall mood of the room will always reflect the attitude of the person in charge of the situation. The reason for this is that people are not sure how interpret what is going on. They will naturally turn to whoever is in charge to get a sense of how severe the situation is. Whenever I had a team leader that was anxious, yelling, and quick tempered, it just made everything worse. No one was able to think or make decisions. Did you know that a person will only retain 30% of what is told to them if they are in an anxious state of mind? This is why it is so important for you to take control of your environment, and establish a calm setting for people to work in.
Some of the most efficient and successful codes came when the person in charge was calm, spoke slowly/clearly, and didn’t appear to be out of control. Working as a CRNA in the OR, I am usually the one making decisions when these type of situations arise. I always tell my CRNA students that the best thing you can do is to maintain a calm, direct, and controlled appearance. Most of the time people will start off anxious, yelling, and confused, but once they see that you’re calm they will begin to settle down. Always take control of you environment and establish a setting that is conducive to good patient care. You will notice that everyone works together better, and the overall experience will be a lot less stressful.
Delegating Doesn’t Make You Bossy
You will be surprise to find that most people are afraid to delegate in emergency situations, because they fear that they will be seen as bossy. This couldn’t be any further from the truth. In reality, people are usually so nervous that they have a hard time making decisions and would love for someone to tell them what to do. When you find yourself in a rapid response, code, etc, don’t hesitate to assign responsibilities to people. One problem that occurs with inadequate delegation is that too many people are trying to do the same job. What ends up happening is that they get in each other’s way, and nothing gets done. You can prevent this by assigning roles to people based on their strengths and weaknesses. If the patient needs an IV choose the person who is known for this type of skill. If a certain nurse is great at charting assign them to be the “recorder”. This simple tip can make all the difference in the world, and often times is overlooked.
Debriefing After an Emergency Situation
A code situation is stressful on everyone involved. I remember being physically and emotionally exhausted after each one. You always seem to go home asking yourself, “Did I do enough” or “What could I have done better”? As nurses we are bad about beating ourselves up on our performance. We want to do the best job possible for our patients. A lot of hospitals are starting to have debriefings for nurses after they are involved in a code situation. I love this idea. Nurses are given the ability to talk about any emotions, fears, or thoughts they have about the experience. This is a time for a positive discussion about what was done right, and any ideas for improving the next time. These types of discussions have proven to lower nurse’s stress levels and improve the overall team dynamics. Debriefing is a great tool and should be utilized by nurses. The best CRNA schools have extensive training in debriefing.
I hope you found these advice tips helpful. We all strive to be the best nurses we can be, and in order to do that we must always be looking for ways to improve ourselves. Never stop learning and always have a positive outlook. Best of luck to all of you!
John Keith | CRNA Career Pro
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