Nurses and Code Blues
Code blues are one of the scariest situations to be in as a nurse. Every nurse should know the basics of code blue because they can happen at any time. Many times a nurse is the first one to witness a patient going into cardiac or respiratory arrest. There is a lot to know about how to run a good code blue.
The best way to deal with a code blue is to prevent a code blue. As a nurse you need to try and round on your patients at appropriate times, even the more stable ones can turn on you. It is understandable that in certain situations hourly rounding is impossible but rounding should never be neglected on purpose. Labs are important and should be one of the first things to look into during your shift and throughout.
What to do during a code blue
It is very important to stay calm and professional during a code blue. The nurse in charge of the situation should delegate tasks accordingly. This includes making sure that when there are nurses available, they are doing what they can for their assigned patient while not forgetting about the other patients on the floor space as well.
During a code blue, nurses should first assess the situation. They need to check for signs of life, and then start CPR if needed. There are times when you can visually see that the patient is not breathing even by the way they look. If you enter the room and are not sure of what is going on with your patient always assess. Call their name, touch or shake them, and feel for a pulse. If there are no signs of life call a code!
According to ACLS guidelines, the adult cardiac arrest algorithm is:
For Shockable Rhythms
- Start CPR (100 compressions/min), attach to monitor and defibrillation pads, and give Oxygen.
- Check the rhythm: is it shockable? Ventricular Fibrillation and Pulseless Ventricular Tachycardia are shockable.
- Shock 120 – 360J
- Continue CPR for 2 min and establish IV access.
- Rhythm and pulse check, shockable? VF/pVT
- Shock 120 – 360J
- CPR: 2 min, Epinepherine every 3-5 min
- Rhythm and pulse check, shockable? VF/pVT
- Shock 120 – 360J
- CPR: 2 min, Amiodarone, lidocaine, treat reversible causes.
- Back to step 5
For Nonshockable Rhythms
- Start CPR (100 compressions/min), attach to monitor and defibrillation pads, and give Oxygen.
- Check the rhythm: is it shockable? Asystole and Pulseless Electrical Activity are not shockable.
- CPR every 2 min and IV access
- Epinephrine ASAP every 3-5 min
- Treat Reversible cause
- Back to step 3 until ROSC or termination
What are the nurses’ roles during a code blue?
There are a few nursing roles to play in a code blue situation and each has its own responsibility. The first thing to understand is that it is not your fault.
The first nurse role is the “lead” aka the nurse who is in charge of running the code. This nurse is responsible for dictating and delegating certain tasks. This should be the primary nurse or a charge nurse because the primary nurse is the one that knows the patient the best and the charge usually has a higher knowledge base and skill set. The primary nurse or a charge nurse are the best people to assess the situation because they have been managing the patient’s care and are our best hope in figuring out what happened.
The lead can then change when a physician comes or another nurse takes over.
The dos and don’ts of a lead
- Don’t take on other tasks or leave the room.
- If you are the lead, you are running the show so know the cardiac arrest algorithm.
- Speak loudly so everyone knows what is going on, make sure people know you are the one running the code.
- If you are the primary hand this role over to the physical and critically think of what could have happened (harder than you think).
IV access and medication
This role can be filled by one or two nurses because getting IV access and maintaining IV access can be a tough job. It is better to have 2 nurses on this job until good IV access is maintained then one nurse can step away and take on another task. You will be administering medications per the cardiac arrest protocol but also some paralytics and sedatives like etomidate, propofol, versed, fentanyl, etc…
Dos and Don’ts
- Don’t stop after the first attempt, keep trying.
- If you are struggling ask for help and keep trying
- Try not to forget the labs
- If pushing med keep the vials so you don’t forget what you gave.
- Push the correct medication.
- Let people know what you’re pushing and when.
the recorder’s role is exactly what its title is, you record. Many nurses don’t like this role because it usually requires you to chart after the code. As the recorder, you write down everything that is going on into time slots. A code blue sheet looks like a spreadsheet. It is your job to also manage time so everyone knows when it is time for a shock, pulse check, and medication.
Dos and Don’ts
- Don’t think you will remember something, always write it down.
- Maintain this role, don’t do other tasks
- Keep your eyes on the clock.
- Know the Cardiac arrest algorithm.
- Speak loudly.
This is usually when the boys come in. Every guy likes doing compressions but just like other things, not every guy is good at them. Always remember 100 – 120 compressions a minute is a way to go. This is also not a one-man job. There should be a person or two ready to hop on the chest. Compression gets tiring so try and switch every 2 min.
Dos and Don’ts
- Don’t be a hero, ask for help, and switch!
- Give good compressions, 2 inches, and push down hard and fast.
- If no one is in line, delegate to someone that isn’t doing anything.
This role can be plated by a few people. Your job is to chase down and meds or equipment. You can also be the one putting in orders for labs, making phone calls to radiology, or getting ahold of anesthesia or a physician.
Dos and Don’ts
- If there are a lot of you, then it is better to stay away
- Try and recognize when the situation is under control and you might not be needed. Sometimes the more bodies the harder it is to run a code.
- Check on the other patients.
- Let people know what you are getting or where you’re going.
- The better you get at this the more efficient you will be inputting in orders or grabbing meds.
Speaking with family
This is a very important role and will usually be the responsibility of the primary nurse. It is always hard letting the family know that their loved one is in cardiac arrest or has passed away. This is a skill that gets better with practice.
Dos and Don’ts
- If you are not sure how to approach a family ask someone.
- Be honest and don’t speak on things you aren’t sure of.
- Ask the family to come in.
- You can always defer some concepts to the physician and say the Doctor will better explain the situation once you arrive.
- Don’t give false hope.
As the primary nurse, try to figure out the underlying causes of cardiac arrest. Look at lab values and prior issues. It’s easier said than done but try to stay calm. If this is not your patient make sure you have a role not just standing by and interfering. If it is your patient make sure to stay in or near the room because you will have to maintain the report. Remember to speak to the family and explain what has happened. Always try your best, brush up on your knowledge, and remember that it was not your fault.
5 Habits to incorporate into your life
If you’ve been feeling like you’re stagnating in life or just can’t seem to figure out what to change, we have a list of 5 habits for you to start incorporating into your life outside of work and inside. We always try to better ourselves or change in some way, you usually start with a self-reflection and then some research. Unfortunately, many people fail to realize that the best habits are fostered when introduced by someone else with life experience.
5 important habits
- Create a Schedule
- What is something you enjoy doing in the morning or what is something you currently do that you enjoy? Maybe you like to meditate, work out, read, or enjoy a healthy breakfast. Whatever it is that makes you feel supercharged, kickstart your day with that habit.
- Establishing a meaningful morning ritual helps you start your day on a positive, proactive note. Having a structured start to your day instead of rushing to make up for the lost time also helps eliminate stress, mental fatigue and enhances your productivity.
- If you don’t know where to start, a good idea is to plan out your morning the prior night. You don’t have to plan out your whole day just think about 1 or 2 things you’ll do after you wake up.
- Do not stay up too late
- What we’ve noticed throughout the years as being the number 1 reason people stay up late is control. People’s lives get busy and some people almost lose control. So just like some drug users seek drugs because their life is in shambles and drugs are the only control they have, you seek to have control oversleep. This type of control is bad because you are tired, your body is saying sleep. You control when you go to bed and you will not let your body tell you who is boss. This is negative control because you lose sleep by staying up too late and this turns into a vicious cycle.
- You can’t comprehend the effect and importance of going to sleep on time or early. You have more functioning day hours and you’ll feel great and more accomplished. Studies show that ⅓ people don’t get enough sleep. Don’t be one of them. https://www.sleephealth.org/sleep-health/the-state-of-sleephealth-in-america/
- Learn to single-task
- There are many people out there that say you need to multitask. What they don’t tell you is that only about 2.5% of people can actually multitask efficiently. https://health.clevelandclinic.org/science-clear-multitasking-doesnt-work/#:~:text=%E2%80%9CWhen%20we%20think%20we’re,are%20able%20to%20multitask%20effectively.
- It’s a simple concept that you think is inefficient simply because math always told you 2 are greater than one. That is not the case in life. Most people are a lot more efficient doing 1 thing at a time. This is especially true at work. Most jobs require you to handle one thing at a time, many people try to do more than one, and then their productivity dwindles and you cant figure out why things are not getting done.
- This goes along well with prioritizing. What is due first, what is something you want to do first, and what is most important are good things to ask yourself before starting that first task.
- Listen and be kind
- This sounds cheesy but it really works. Some people are struggling in life and just a simple conversation lights up their spirits. We all need outlets and the greatest outlet is speech. It is really that simple. Not only will you make someone’s day you will also learn something. This is also important at work, especially in the medical field. Just by actively listening you can figure out what is going through your patient’s head. You’ll be better at treating not only their medical issue but you’ll also be helping them on a mental and emotional level.
- What goes around comes around. What energy you give to this world you receive back. Too many people surround themselves with hate and anger and you can feel it. There is too much negativity in this world so start doing kind things for others. It would blow your mind how much good advice and free things you can get just by being nice. People are at different points in life and in situations, we might not be able to comprehend. Share the love and you’ll get love back.
- Always try to learn
- By this, we mean to try and experience everything. Conquer your fears inside of work and out. Treat every experience as a learning opportunity. Try and do new things.
- Being uncomfortable is the area for growth. Learning is hard and it’s usually uncomfortable because you are dealing with something unfamiliar.
Moving Out After Nursing School
How soon did you move out after nursing school?
There is no ideal time frame. Some nurses do it a few weeks after landing their first job, some wait a few years and build up their finances, while others have already been living on their own. Moving out is a big part of your life, so make sure to think it through. Why do you want to move out? Is it because everyone is doing it, you want more space, you want more freedom, etc… You may think; what are the benefits of moving out after nursing school.
Things to consider before moving out
Finally getting to move out of your parents’ home is one of the greatest and most accomplishing things you will do in your lifetime. It puts you in a point of optimal growth, you’re going to experience life on a different level. These are some steps to take before you move out.
- Figure out your financial situation
- If you want to move out you first have to make sure you have enough money. There’s a thing called rent or mortgage for everyone still living at their parents’ home. You’re going to be paying for the place you are living in and it is going to be your most costly expense. The average cost of rent in the US is a little over $1,000 a month, depending on the location you will most likely be paying more. For example, a 2 BR condo in LA will run you around $3,000 – $5,000, in Chicago $1,800 – $3,000.
- You also need to incorporate groceries, utilities, Netflix, phone bills, and personal expenses. It all adds up and it’s usually a lot more expensive than you initially thought.
- Consider your loans. What are your monthly loan payments? You might be better off living at home for a few months or years longer to get them paid off quicker.
- Where do you want to live
- Location, location, location, one of the biggest real estate owners is McDonald. You need to think about where you want to live, city, suburb, local, or out of state. Is there a particular spot you always go to or really like? Do you want some views, or maybe live close to your parents.
- Why do you want to move out
- Moving out is a lot of work and increases your responsibility. Are you moving out for the right reasons or are you mindlessly doing it because everyone else is?
Benefits of moving out
- More freedom: You will not have a room anymore, the whole place will be your temple. You can do whatever whenever walking naked from your bedroom to the kitchen kind of freedom.
- More responsibility: You will now be a fully functioning adult with complete control of your life and future. You are going to learn all the things associated with living at your own place; decorating, cleaning, fixing, maintaining, etc… It is a new sense of being.
Managing Your Finances as a Nurse
Managing your finances is something schools and universities still neglect. Coming out of college some people don’t know how to open a bank account. A career in nursing can be lucrative when it is done right. The highest nursing salaries also allow you to pick and choose where you will work around the US.
We also did a great episode about how to pay off debt and save money with the DebtFreeNurse
Understand how much you get paid
The 2 biggest things in understanding your pay are; there is a difference in the amount you get paid by your employer and how much you take home. That is called net and gross income.
- Gross income = Income before taxes
- Net income = Income after tax (the amount you actually get)
It’s always good to know how much money you make on a yearly basis as well as know your average paycheck total.
- If you make $2,800 biweekly then your monthly income is double, $5,600/month
- That’s $67,200 a year
Your income means that just by yourself you already make above the median household income of the US, according to the median income in 2019. Median household income was $68,703 in 2019, an increase of 6.8 percent from the 2018 median of $64,324.
It is also important to take into account how much you pay for insurance. Most people get health insurance, dental, and vision through their employer. It gets taken out directly from your paycheck.
Understand your bills
We are entering a more and more subscription-based society. It is a lot harder to keep track of monthly occurring expenses vs a one-time payment basis. What makes it tricky is they offer something low cost with improved tiers which don’t seem like a lot at the time but multiply it for the year and it might add up to $1,000.
Some staple bills to always keep in mind are; cell phone, internet, home bills (gas, electric, water, rent), Netflix, apple subscriptions, and car insurance.
Take into consideration your costs of groceries.
Create a budget and stick to it
Knowing your income and expenses is the key to understanding your financial situation. Once you have those understood it is time to create a budget. When making a budget to add up all the money you make from work and add up all your recurring monthly/weekly expenses.
This gives you an idea of how much you make and basic necessary spending. This also gives you an amount left over. You need to budget the money you have leftover when you subtract your expenses from your income.
The money you have leftover is technical your “spending money”, but that also accounts for money you want to save. This is the money you have to do things outside of food, shelter, water, etc.. Your budget should consist of 2 major things; money to save and money to spend.
It is important to realize what percentage of your money goes where. The best way to make a budget is to break it down into months. X% is devoted to categories like bills, food, restaurants, ets.. Let’s take $4,000/month of income for example
- 40%: $1,600 in monthly bills (water, loans, mortgage, rent, comedy, internet, cellphone, etc..)
- 15%: $600 on groceries
- 25%: $1,000 saving
- 10%: $400 extra
- 10%: $400 eating out/leasure
Starting with just breaking down to the major categories gives you an idea of how much money it actually costs to live and how much you really make. Once you have the fundamentals of the budget you can then add other categories like goals, or you can rearrange where your money goes. Once you have a budget you can safely save and spend. It’s about understanding your money not how much money, at least in the beginning.
Saving and Paying off debt
The biggest and most inconvenient things about being an adult are saving for the now, saving for the future, and paying off debt. The best way to battle debt is to not get in it in the first place.
The number one rule with paying off debt is to pay the high interest off the quickest because that’s the one that is charging you the most for borrowing. Another good step would be to pay your credit off in full if you have the chance to instead of just adhering to the monthly payments. It is also good to use your leftover income to get used on the loans, trying to make a higher than your regular/minimal monthly payments because you’ll pay it off quicker.
When it comes to credit cards you should use them like a debit card. Only spend money you have, not money you will have. The majority of the time it is more beneficial to use your credit card so you can earn points and build your credit. Most debit cards don/t offer any perks.
It is good to save outside of your 401k, most employers over a 401k plan which makes it very simple. You should still have a savings account as your savings for the short term. In your savings, you should also have an emergency fund with at least 3 months worth of living expenses.
Understand your credit score
Your credit score is a three-digit number that can have a big impact on your finances. Lenders are willing to offer borrowers with high credit scores better loan terms and lower interest rates.
As you apply for large loans such as a mortgage, a small interest rate reduction can save you thousands of dollars. Credit scores generally range from 300 to 850
What Factors Impact Your Credit Score?
- Pay your bills on time, every time.
- Pay off your debts as quickly as you can.
- Keep your credit card balance well below the limit.
- Applying for multiple credit cards
Today we’d like to welcome Tasha Triana. Tasha is a Southern California native, world traveler of 25+ countries, registered nurse of 8+ years, certified yoga and meditation teacher, and Reiki practitioner. Tasha founded her business, The Nurtured Nurse, to teach nurses how to prioritize their own self-care and wellness so they can show up feeling replenished and empowered to live their best lives.
This is Tasha’s second time returning to the show, she was previously on EP 56, where we covered nursing, burnout, mindfulness & mental health.
Questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!
- Card reading, Arch Angel or Animal
- A little bit of background
- Masters in Psychology
- Why did you go into it, what were/are your intentions?
- Nurtured nurse private coaching (Shameless Plug)
- Future Retreat
- What is the purpose? Are there different types?
- What is it to you?
- How did you get into it? What made you start?
- How has it changed you and how have you incorporated it into your life?
- Yoga: Different types of yoga.
- How does it feel, the purpose?
- Why/when did you get into yoga
- How to become a Yoga Teacher
- How did you get into it?
- What is it?
- A healing technique based on the principle that the therapist can channel energy into the patient by means of touch, to activate the natural healing processes of the patient’s body and restore physical and emotional well-being.
- The word “Reiki” means “mysterious atmosphere, miraculous sign.” It comes from the Japanese words “rei” (universal) and “ki” (life energy). Reiki is a type of energy healing.
- The practitioner places their hands lightly on or over specific areas of the head, limbs, and torso using different hand shapes, for between 2 and 5 minutes. The hands can be placed over 20 different areas of the body.
- How has traveling shaped you to who you are today?
- What was the biggest takeaway from traveling?
- Tell us about your journey into tapping into the inner self?
- What has been your favorite routine or daily habit lately?
Where can we find Tasha: https://www.thenurturednurse.co/
What to Expect After Your NCLEX
In this episode, we are going to discuss the things you have to do once you’ve passed your NCLEX. In nursing, the work seems to never stop. So, you’ve passed your NCLEX and you are crossing over from student to practitioner. Your next step should be applying to jobs, but on a unit, you want to work on.
Before you apply for a job
When you are looking for a job there a few things to consider. Get your paperwork together, this includes your:
- RN License number
It is always beneficial to keep these items stored together because you are going to be using them a lot for the rest of your life. When you apply to a position you will be filling out a lot of information such as:
- Experience, etc…
You will also need to input your license number and even proof of graduation.
Some Universities offer a resume-building workshop or even have it be a requirement to create one in class. We highly recommend checking out our friends at https://www.theresumerx.com/. We even had Amanda Guarniere on our show, EP 74.
Your resume should consist of:
- Contact Information
- Opening Statement: Summary or Objective
- Work History
- Soft Skills and Technical Skills
- Certifications and Professional Memberships
- Achievements and Awards
- Additional Sections (Community Involvement, Volunteering, etc.)
Applying to positions
The best place to start looking for jobs is the closest hospital to you. This is the most convenient as some people find themselves driving for 30 – 60 min one way to work. Driving that long shortens your days by about 6 percent.
You should also ask around. Do you know anyone already working in the hospital or clinic? It’s always easier to get into a job knowing someone already there.
Many people recommend taking the first job you get or to start within a specific unit to learn some basic fundamentals. However, we believe that you should always aim for something that you specifically want and exhaust all options before moving on to something different. This gives you the best chance of figuring out what you want to do in nursing.
The turnover rate is high regardless of what unit, you may realize that the unit you had for your capstone, that you really liked, wasn’t meeting certain expectations. Know that this is completely normal and do not freak out, it takes some time to figure out what you really want to do. Maybe you tried Peds and realized that you get too emotional around kids, it’s normal to switch. Remember you want to work in a place you are comfortable and enjoy working in.
If you aren’t a new grad and are applying to different jobs, take travel nursing into consideration. Take this summer to think about it and when August comes around you can make your decision for September. That is a good way to think about it because it is always an option, and who doesn’t like traveling.
Some of you may have never been in a job interview, you may have some experience with interviewing for nursing school or a mock interview, but those don’t compare. We are not going to walk you through the whole interview process but we will offer you some good questions to ask your future employers.
- Do you offer a new graduate nurse program? (if you’re a new grad)
- How many weeks, what shift?
- Will I be paired with 1 nurse or multiple?
- Verify that it is the correct shift – make sure it is a day’s position if that’s what it said on the jobs posting. Ask if there is a chance to switch shifts, but understand what shift you applied for.
- How is the workplace culture? Is there a high turnover rate?
- What are the nurse-to-patient ratios on a busy day?
- What are the weekend, holiday, and overtime arrangements?
- Is there an opportunity for leadership positions and school reimbursement?
- When should I expect a call or notification of my acceptance?