In this episode, we will be talking about Code status. This is not only for medical professionals; this should also be known to anyone listening. The topic of code status can be confusing to many. Too often, code status is not discussed fully until a crisis with one’s health status.
Your chosen code status describes the type of resuscitation procedures you would like the health care team to do if your heart stopped beating and/or you stopped breathing. Resuscitation procedures are provided very quickly during this medical emergency to keep you alive. This emergency procedure is commonly known as cardiopulmonary resuscitation or CPR.
In the same way, there are different treatment options and goals, and the expected outcome after a cardiac or respiratory arrest differs depending on the person, the severity of the illness, the cause of the arrest, and other factors. It is essential to discuss code status before a crisis occurs and as a condition changes.
The Outcome of Resuscitation
Cardiac arrest is when the heart stops beating. About 350,000 cases occur each year outside of a hospital, and the survival rate is less than 12 percent. CPR can double or triple the chances of survival.
Even though CPR can restart someone’s heart, it can cause harm or even prolong the dying process. The success of resuscitative efforts is not like how it is shown on tv; the stats are relatively low. In 2016, the survival rate for adults after a cardiac arrest were:
Out-of-Hospital Arrest: 12%
In-Hospital Arrest: Less than 25%
Survival rates are lower for patients with advanced age, cancer, sepsis, renal failure, or liver failure. The survival rates for patients with a chronic or advanced illness average 5% and less than 1%, respectively.
More than 40% of survivors are discharged with a significant decrease in their functional ability.
Different Types of Code Statuses
Like there are different treatment modalities, there are different code statuses. There isn’t only 1 route, and you can choose different options. However, there is a limit to what we can and can’t do.
Full Code: We do anything and everything to try and bring you back. This includes CPR, intubation, medications, lines, and procedures.
DNR: This is a Do Not Resuscitate order. When your heart stops, we will not attempt to do anything. We will let you pass without any interventions.
Partial Code: This one can be a little complicated because there are a few measures you can choose to have done or choose not to have done.
Meds Only: If your heart were to stop, we would not perform CPR or intubation. What we would do is use medication to bring you back. We can push epinephrine, give bicarbonate, start levophed or other pressors to try and keep your heart beating or start it back up.
No CPR: Some patients do not want CPR performed but are open to everything else. Defibrillation, intubation, and medication are all used.
Advanced Directives
Advance directives are legal documents that allow you to write out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and healthcare professionals and to avoid confusion later on.
Health Care Power Of Attorney
The purpose of this form is for an individual to be named your advocate if you cannot make your own decision, even temporarily, such as in an accident. This person should know how you feel about life-sustaining treatment and other vital issues. This person does not manage anything related to your finances. First and second alternates may also be identified if the primary cannot be immediately reached.
Talk about why Code status is essential and different situations.
Here’s what you know to know about these codes. Watch the full episode here 👇👇
TIMESTAMPS:
00:00 – Intro 01:00 – Topic introduction 02:07 – Why do we talk about the code status? 04:37 – What’s your relationship with death? And how do you cope? 08:48 – What is Code Status? 09:25 – Polish parents and Code Status 12:40 – Religious Beliefs and Code Status 14:36 – Turning Acute illness into Chronic issues 17:14 – Outcome of Resuscitation facts 20:38 – Codes happen during a change of nurse shifts 22:34 – Freezing the body after surviving the code 25:11 – Different kinds of Code Status 33:35 – Post Code Status scenario 35:10 – Advance Directives 37:50 – Don’t Let Your Family Decide 41:05 – Educating the patient’s family 47:04 – Your takeaway 48:16 – Wrapping up the show 48:42 – End of show
Professionalism as a Nurse: Balancing Work and Social Media
Balancing work and social media is possible. As the age of social media grows, the borderline between Professionalism and social life is drawing nearer. How much can we show on social media, or what can we offer? Social life used to be our private life, but in this generation, we have everything but privacy.
Nursing is a field where professionalism needs to be expressed daily. Nursing revolves around critical thinking and life-saving measures with minimal room for mistakes. How much of your life should you be revealing on social media?
Are you developing Professionalism in the workplace?
In nursing, there are always new and changing areas to improve. Nurses should self-reflect on their actions in the workplace and integrate new, experience-based knowledge into their daily practices. Here are six skills that contribute to professionalism.
Conflict Resolution in Balancing Work and Social Media
Are you able to de-escalate a problem professionally? For example, for an alcohol detox patient that is agitated, how can you safely communicate solutions concerning your patient? Resolving conflict may require the nurse to consider the needs of everyone involved in the situation.
Ethical Thinking
This means we should never lose sight of our positive purpose. This enables the nurse to make a value-based judgment that aligns with professional standards and moral conduct. Nurses are advocates for patients and must find a balance while delivering patient care. Ethics has four main principles: autonomy, beneficence, justice, and non-maleficence.
Adaptability
This demonstrates the capacity to combine new information with education, experience, and professional guidelines to re-evaluate a situation and make changes that lead to more effective outcomes.
One example is being on committees and solving issues in the hospital setting. Sometimes it can be on a micro-level, like changing things on the unit to increase productivity and workflow.
Leadership
Leadership is founded on excellent communication skills, attention to detail, respect, and resourcefulness. Professionals often build leadership skills as they move on to more managerial roles.
Leadership doesn’t always have to be gained from advancing in positions. You can be a great leader working as a bedside nurse. Can you inspire others to work together to pursue common goals, such as enhanced patient care? An effective leader has distinctive personal qualities: integrity, courage, initiative, and the ability to handle stress.
Collaboration
This is key to Professionalism. Working with others and being able to communicate and cooperate is crucial to developing an efficient work environment that places patient needs at the forefront. As nurses, we collaborate with doctors, patients, and their families in shared-decision making.
Positive Attitude
Far too often in nursing, we are burnt out and tend to complain more about our shift than having anything positive to say. A worried patient’s last need is a negative nursing team supporting them.
As nurses, you are the face of the profession and thus must work to maintain a positive environment and communication in all areas and at all times. It is an excellent practice to be able to identify negative thoughts and address them before they begin to harm your nursing team.
Privacy Issues with nurses and social media
According to HIPAA, “Patients hold the rights over their health information, and it establishes rules and limits as to who can receive it.” A patient’s information is considered protected health information, and it is anything transmitted or maintained in electronic media or any other form of media.
The NCSBN only allows medical information to be shared under three circumstances:
The patient has provided informed consent
In situations in which it’s legally required
When failure to disclose the information could result in significant harm
4 Ways You Can Breach Patient Confidentiality
Videos or photos of patients, even if they cannot be identified
Photos or videos that reveal room numbers or patient records
Descriptions of patients, their medical conditions, and/or treatments
Referring to patients in a degrading or demeaning manner
What not to do with your social media
You can do many things and post on social media, but as nurses, we have more responsibility than others. Here’s what you need to know:
Complain about work or your patients
You might have had a bad shift and a horrible night, but social media shouldn’t be the place you express your thoughts on the last night shift. Specifically, you shouldn’t mention anything regarding your patient or unit. You may not think you are breaking HIPAA, but the word can get around. Do not use any patient identifiers. Your employer and patients can be looking at your socials.
Post pictures
There have been many nurses that got fired for posting something we might view as no big deal. Nurses have been fired for posting a messy room after a code. Keep that in the hospital.
Use offensive language and comments.
Our patients come from different backgrounds, and we must view them all as equals. Social media is not the place for you to bash patients’ viewpoints or beliefs.
How Balancing Work and Social Media Helps Nurses
As a nurse, you can use social media and your degree to their full potential. As a nurse, you are regarded as someone that cares for the health and well-being of others. You are a fountain of knowledge, and many people will look to learn from you. Use your skills and knowledge to your advantage.
As a nurse, you should be spreading what you know. Many nurses are into health and fitness; sharing that on socials or promoting a fitness brand or a vlog is all ok. Spreading education and discussions allows people to learn from you.
There is nothing wrong with talking about case studies and different disease processes. Nurses have used their knowledge and experience to bounce from nursing to entrepreneurship through social media by pursuing multiple passions.
Remember that your current and future employers will likely see your social media. Use that to your advantage by being professional. Remember to express yourself professionally and honestly.
To watch more on this episode, click here 👇👇👇
TIMESTAMPS:
00:00 – Intro 00:45 – Topic introduction 01:06 – Nurses and HIPPA guidelines 03:15 – A Moral Compass 04:25– Developing a professional personality 04:38 – Conflict Resolution 08:44 – Ethical Thinking 12:00 – Adaptability 15:18 – Leadership 17:44 – Collaboration 29:44 – Privacy Issues with Nurses and Social Media 32:29 – Four Ways to Breach Patient Confidentiality 35:05 – Don’t complain about your patients on social media 39:55 – Provide value with what you share 41:03 – Nursing and Fitness 42:55 – Communication is the bottom line 48:48 – Wrapping up the show 49:03 – End of show
Covid 19 is still widespread in the world. Countries including the US are pushing for another shutdown. Candida Auris is a new emerging multidrug-resistant fungus that is becoming a problem. The US elections are at complicated crossroads. Citizens react in protest as the law for abortions in Poland tightens.
Global and US Covid Stats
Cases: 50,123,657 Deaths: 1,255,392
US: 10,166,227
Deaths: 243,186 Recovered: 6,433,976
US Case Count
Texas – 1,011,237
California – 967,468
Florida – 837,077
New York – 562,036
Illinois – 477,978
Candida Auris
10/26 case count 1,364. It has also been reported that NY and IL have the most cases. Candida Auris is an emerging fungus that presents a serious global health threat. CDC is concerned about C. Auris for three main reasons:
It is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections. Some strains are resistant to all three available classes of antifungals.
Think of MRSA – methicillin-resistant Staphylococcus Aureus
It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. Auris in hospitalized patients so that healthcare facilities can take special precautions to stop its spread.
From the CDC website: “We don’t know if patients with invasive C. Auris infection are more likely to die than patients with other invasive Candida infections. Based on information from a limited number of patients, 30–60% of people with C. Auris infections have died.”
Hospital protocols for C. Auris
No stethoscopes, equipment, or other items from outside rooms.
Proper PPE (gown, gloves) Can’t enter without proper PPE for a “quick IV adjustment”
Wipe down the work area with Oxivir or bleach x1 a shift. This includes IV pumps, computers, isolation cart & other services.
No C-Auris patient should be paired with post-op patients, ECMO, CRRT, or other high-risk patients
Wash your hands with soap, 20-sec scrub
How is it diagnosed?
C. Auris infections are usually diagnosed by culture of blood or other body fluids. However, C. Auris is harder to identify from cultures than other, more common types of Candida.
It can be confused with other types of yeasts, particularly Candida Haemulonii.
Who is at risk?
People who have recently spent time in nursing homes have lines and tubes that go into their bodies, such as breathing tubes, feeding tubes, and central venous catheters.
Risk factors for Candida Auris infections are generally similar to risk factors for other types of Candida infections [1].
Recent surgery
Diabetes
Broad-spectrum antibiotic and antifungal use.
Infections have been found in patients of all ages, from preterm infants to the elderly.
How do we treat it?
Most C. Auris infections are treatable with a class of antifungal drugs called echinocandins. Some C. Auris infections have been resistant to all main classes of antifungal medications, making them more difficult to treat.
In this situation, multiple classes of antifungals at high doses may be required to treat the infection.
Death rate
⅓ people die due to complications caused by C. Auris
C. Auris infections are more likely to die than patients with other invasive Candida infections.
30–60% of people with C. Auris infections have died. However, many of these people had other serious illnesses that also increased their risk of death.
How did it spread
CDC conducted whole-genome sequencing of C. Auris specimens from countries in the regions of eastern Asia, southern Asia, southern Africa, and South America.
Whole-genome sequencing produces detailed DNA fingerprints of organisms.
CDC found that isolates within each region are quite similar to one another, but are relatively different across regions. These differences suggest that C. Auris has emerged independently in multiple regions at roughly the same time.
Poland Moves to Near Abortion
The highest court ruled that abortions in Poland, due to fetal defects are unconstitutional, moving the country towards a near-total ban on terminations and sparking angry protests in the capital Warsaw [2].
Warsaw Mayor Rafal Trzaskowski said more than 100,000 people were in attendance.
Police detained 37 people Friday, the vast majority of whom were football hooligans, Sylwester Marczak, spokesman for the Warsaw Police headquarter. Taking into account the huge number of participants, it was a “very peaceful” protest, he added.
Around 98% of abortions in Poland had been conducted as a result of fetal defects, meaning the ruling bans virtually all termination procedures taking place in the country. It could force women to carry a child even if they know the baby will not survive childbirth [3].
How to build confidence as a nurse? Sometimes in nursing, even the most experienced nurses face a new situation, making them feel like their confidence is shaken. Nursing has those moments that make you wonder if you’re even in the right profession.
When you begin orientation as a new graduate nurse, you know one thing: nursing school doesn’t teach you everything you need to know to succeed on the floor.
When standing, imagine a string pulling your head up toward the sky. Picture a straight line exiting your earlobes through your shoulders, hip, and the middle of your ankles.
Eye contact to look at a human and acknowledge them as a human is a common courtesy. Whether it’s a handshake or asking how you are doing.
Don’t compare yourself to others.
Nothing will take your confidence away faster than comparing yourself to others. Getting caught up in thinking about how your co-workers are sizing you is easy. And while you want to be part of the team and fit in, it’s so important not to let other people’s (perceived) opinions about you cause you to lose sight of why you’re there!
The truth is, human beings make judgments, and typically their conclusions have far less to do with what you’re doing and more to do with themselves! Spending time trying to make others like you (and not acting like yourself) is a recipe for disaster.
Expanding your knowledge
In medicine, knowledge is power; when we feel educated about a particular circumstance, we tend to feel more confident in our abilities. Usually, time is the most significant factor in experience and gaining confidence. You can also take additional workshops, classes, and seminars to expand your judgments.
Education also doesn’t have to be just nursing; it can be like leadership. Handling a specific situation or resolving conflict will help you stand out and get acknowledged, boosting your confidence.
Asking questions
You hear us talking about this all the time, but it’s that important. It even happened to be this past week having a question about the pacemaker. Avoid falling into the trap of thinking you know everything. That is when you become dangerous.
It’s better to be sure than to make a mistake, especially in the life-and-death world of nursing. Also, if you have a question, there is a good chance that someone else has the same or a similar one.
Practicing self-compassion
Let’s say you miss an IV after two tries and spend the next few minutes (or hours) putting yourself down mentally. That negative behavior won’t serve you or your patients.
When things don’t go the way you want them to, or you make a mistake, speak to yourself the way you would your good friend. You wouldn’t tell them everything they should have done differently or suggest that this isn’t for them.
Instead of “I’m never going to understand all of this; it’s too much information to remember.
Try this “I am a new nurse learning a lot of new information; I will be patient with myself to learn. This is part of the process.”
Also, do your best to limit your comparison only to how well you did yesterday. Imagine comparing yourself to coworkers constantly that, “She passed meds faster than me every time.”
Travel nurses and confidence
Travel nurses often experience a “crisis of confidence,” especially in the early days of any new assignment. Even if they know they have been well-trained and have a wealth of experience, entering a unique situation and working with a new group of colleagues presents a challenge.
There’s usually a learning curve as you get to know the personalities and politics of the department and the facility. You might feel like everyone is watching you, the “new kid,” to see what you can do — and whether you will make mistakes. While little besides the time can help you get past the first-day jitters, you can build your confidence as a nurse in the future and reduce those nagging feelings of self-doubt.
Bottom Line
Even when you have been a nurse for many years, there will be situations that shake your confidence. If you stay focused on improving your skills, self-talk, asking questions, and relationships with others, you’ll gain the self-esteem you need to handle anything that comes your way.
Gain your confidence as a nurse by watching this whole episode here 👇👇👇
TIMESTAMPS:
00:00 – Intro 00:17 – Show intro 00:50 – Topic Intro 01:54 – How to Build Confidence as a Nurse 03:03 – Posture and eye contact equal your energy 05:25 – How do you know if you have good posture? 06:32 – Don’t compare yourself with others 09:32 – Expand your knowledge 13:55 – Asking questions 17:24 – Practicing self-compassion 19:27 – Travel Nursing Confidence 23:10 – A recap 23:32 – It’s a wrap!
Have you ever wondered how it feels to work as a night shift nurse or how people transition from working nights to days? We will explain how to transition from a normal schedule to working at night. We want to help optimize your schedule, sleep, and eating so that the night shift doesn’t destroy you.
Night Shift Nurses
One of the most difficult careers out there is nursing. Nursing is similar to all medical careers in that it is a 24-hour job. This means people are working all around the clock. 24-hour careers require a certain amount of people to work the night shift.
The hardest part about working as a night shift nurse is the transition over to it. We are not nocturnal animals. We are meant to be awake during the day and asleep at night. Our circadian rhythms are programmed under the awake during the day and sleep during the night cycle. The key to being able to work the night shift is having a proper schedule during your shift and outside. The transition between nights and days is what most people seem to find the hardest.
Here are some tips on how to have better night shift transitions.
Your Schedule
How do you like to line up your work schedule? Different nurses have different schedules when trying to work the night shift. There are only so many nights a nurse can work in a row.
3 in a row: There are a lot of nurses that work 3 in a row and then are off for the next couple. This is good because you are not transitioning from night to day as often. It is hard to do because the quality of life between shifts isn’t very high. In between shifts, you won’t have much time for anything besides eating and sleeping.
Every other day: There are nurses out there that enjoy working every other day. This gives you room in between shifts to recover and take care of errands.
2 on 1 off: the most common one for nurses is to work 2 shifts in a row and then their third shift another night in the week. It is hard to do 3 in a row, and some nurses rather just do 2. You aren’t transitioning back and forth as much as every other, and it still allows you to do stuff in between shifts.
Your Sleep
Your sleep-wake cycle is going to be changing a lot when working the night shift. The biggest struggle for night shift nurses is getting enough sleep and not feeling tired.
Aim to get at least 8 hours of sleep.
Some people can function with less, if you can get away with 6 then work on 6. You need to find out what your minimum is. There is going to be a difference between how much sleep you’ll need between shifts vs your off days.
Take a nap before work
If you are a night owl you won’t need as big of a nap prior to working. The typical morning owl working the night shift is going to most likely need a long nap. Believe it or not, there are different nap times and their benefits.
Power nap: 10-20 min, energizing nap. Good for when you are feeling a little drowsy
Short-term nap: 30-60 min. The body begins to enter deep sleep. This can help with memory but it takes about an hour to be fully alert again.
REM nap: 90 min, equal to about 1 sleep cycle. Shown to help with memory and learning new skills.
The nap you should take depends on how you feel. A good idea is to wake up at least 2 hours before the tour shift, especially if you are taking a long nap.
When to sleep
When you are coming off your shift and have to be up for another, it is always wise to shower and go to bed. You shouldn’t be running any errands. Most of the time, you will be exhausted after your shift; there’s no need to tire yourself out even more.
Sometimes nurses have trouble falling asleep after a night shift. They have the energy to expel because, naturally, their body is telling them to wake up. After all, the sun is out. If you have a hard time falling asleep after you get off a night shift, do something simple that can burn that energy. Going to the gym or going on a run for a few minutes helps most nurses.
When you are coming off your shift, and you’re off the next day, there are a few options you can take. It will depend on under which one you can function best and on how many days off you have.
1. Going directly to sleep: most nurses choose this route. They go to bed after their shift and wake up later on at night as if they would be going to work. They start their day off that way. The negative part is that you’ve slept the day away but it doesn’t mean you can do anything else. Most of the time nurses focus on little tasks that can be done quickly or at home to be productive on their first day off. You’d be usually awake from about 7 pm until midnight or 1 am. You don’t want to stay up too late because you want to continue onto a dayshift schedule the next day.
2. Staying up all day: Some nurses choose to stay up the whole day and then go to bed early. This is the hardest route to take but probably the most effective if you are trying to transition back into days quickly. Nurses that choose this route stay up all day and then usually go to bed early.
3. Staying up than napping: Another route is to stay up for a few hours take a nap and continue the rest of the day. Some nurses transition by getting off shift at 7 pm running a few errands then taking a nap around noon for a few hours, waking up, and continuing their day.
4. Napping after the shift: A good amount of nurses also get off work take a small nap and continue their day. There are a lot of nurses that do this and it helps with transitioning to days while still being productive throughout the day.
Sleeping environment
As night shift nurses we sleep during the day. To get the quality sleep you need to sleep in a dark room. Light inhibits melatonin production and it will make it hardware for you to fall asleep.
Sometimes the thing that is making your nightshift life hard is the foods you eat. We know that high sugar and high carb foods are associated with insulin spikes leading to spikes in energy. These peaks and troughs may be putting a toll on your body. Make sure to optimize your nutrition.
Eating schedule
When is the best time to eat? Unfortunately eating food at night is never ideal so there really is no best time at night to eat. It will depend on your schedule. Since your body is created to be eaten at night it won’t depend so much on the time that you eat but it will depend on what you eat. Make sure to always eat a meal prior to going to work, ideal 2 or 3 hours prior.
Intermittent fasting: intermittent fasting has been shown to have many benefits and as a nurse, you can still get away with doing it. It isn’t for everyone but it can help with your transitioning. If you work better when you have a set schedule this may be good for you but pick a time that you don’t need to flip between on your off days. For example, fasting from midnight until 4 pm may not work for you because you won’t have much time to eat at work but noon until 4 am won’t work on your days off.
Big meals vs small: some people prefer to have frequent smaller meals throughout their shift. This can help them stay awake as well as increase energy. The drawback is that you will need to make time for eating more often. Some nurses eat one or 2 larger meals at work. This is good because it will keep you full longer so you aren’t always picking at your food, however, most people do feel more tired after a larger meal.
Always eat before work: Make sure to always eat a meal before coming to work so you aren’t hungry or thinking about food right away.
What to eat
The first thing you need to do when you are struggling with the night shift is to cut down on sugary snacks. They taste good and might wake you up a bit but they’ll make you more tired when you crash. Dieting is completely doable while working nights, you don’t need to sacrifice your diet but you still need to stick to it.
Eat foods that make you feel fuller longer, many times these will be foods that are high in protein.
There is no secret food to help you with working nightshift, you need to find what works for you. The key thing is to eat healthily.
Bring healthy snacks. You will have the urge to snack, that is why it is important to bring your own healthy snacks.
This goes for outside of work as well. Maintain a healthy diet in and out of work. Your body will need optimal nutrition especially when it is put in suboptimal situations like working nightshift. If you have a well-balanced eating structure your body will be better at taking on the stress associated with nightshift.
Drink plenty of water
As a night shift nurse, dehydration will make you feel tired and depleted. Make sure you drink plenty of water and use the bathroom.
Caffeine
Caffeine is a drug and there is a proper way to use it. You do not want to be over-caffeinated because that just leads to a giant crash. Drink coffee or an energy drink with a purpose. The onset of action for caffeine is about 1 hour and lasts about 3-4 hours. Plan to drink your coffee accordingly and in appropriate amounts.
Recovering From Night Shift
Recovering from your nights is just as important as working. Make sure to have a routine on your off days. Get some exercise and make healthy food choices. Your body’s life consistency and any aspect that you are consistent with will help with working nights. Plan out days for yourself, and be mindful of how much you are working and when you are burnt out. The better you are at having consistency the better outcomes you will have with working nights.
Transition as a night shift nurse easily. Watch this full episode here 👇
TIMESTAMPS:
00:00 – Intro 00:30 – California weather 01:22 – Transitioning from Night Shift to Day Schedules 02:57 – A morning person 04:06 – The night shift makes you sleep more 04:57 – Are morning people more disciplined? 07:00 – Consider your schedule when transitioning 11:05 – Meal prepping matters 12:20 – Sleep-wake cycles 12:37 – Aim for 8 hours of sleep and take naps 24:07 – Get proper nutrition during your shifts 25:57 – Snacks make the shifts a lot better 27:50 – Post-surgery bowel movement (Pete’s) 30:20 – Choose healthy snacks 34:28 – Everything must be on a schedule 35:44 – End of show
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