Kelly Danielle Boykin - Pacific Medical Training

Submitted 2022-11-01

As a Critical Care RN, you will be the second line of defense for patients after they have received initial stabilization in the Emergency Room. In this position, you will be the first line of defense for patients being emergently transferred from acute care to a higher level of care. Patients arriving from either destination are often unstable and in need of interventions provided quickly and effectively. If you think this sounds like a lot of pressure, you are correct. It is important that you keep yourself focused, level headed, and perform the skills you have learned with speed and accuracy. More importantly, you must learn to be a clear communicator.

Shifts are long and the pressure of Critical Care nursing can be quite intense. Taking care of your physical being will enable you greater mental clarity and physical endurance. Good nutrition comprised of whole foods will fuel your body and mind for performance. Eating balanced meals regularly will support your glucose levels and your mental acuity. For myself, I have found that consuming whole grains in the amount of fifty percent of my calories has greatly increased my mental alertness while on shift.

Sleep is a basic need that healthcare workers often toss to the side. Decreased sleep is shown to decrease mental acuity and response time. Losing out on regular sleep also increases the stress hormone cortisol. Investing time into finding ways to get ample sleep will be well worth your time. Whether it be meditation, regular exercise, a sound machine, or another sleep aid; finding a solution early in your career will pay off. I personally use regular exercise on my days off and meditation on my work days.

Keeping yourself strong will assist you in emergency responses. If the only resuscitation experience you have had is pumping on a manikin for two minutes, you will be surprised at how much several rounds of resuscitation takes out of you. Although as nurses we rush around all day, moving while at work does not actually count as endurance or strength training. Your patients are counting on you to be physically ready to perform a multitude of tasks including rolling their entire body. In an emergency, we often forgo lifts and tools and use shear strength to gain response speed. A workout routine on your off days will help you to stay strong and have balanced musculature. I weight lift on my four days off to stay primed and ready for emergency response.

During your training you will study the emergency skills you will need to perform during a patient emergency. The best way to prepare for an actual emergent response is to become familiar with the tools that could be in use and to run scenarios. This will help you to be familiar with the medical devices and help you to develop muscle memory. Developing muscle memory will assist your performance when your anxiety is at its highest. I am lucky that the hospital I work for runs code drills frequently. For myself, I read and act out trauma scenarios utilizing my RQI workbook.

The more daunting portion of emergency response is the actual medical knowledge. I’m going to tell you two conflicting things. First, I will tell you that you need to study. Study before you start your career and once you are actually working in emergency care. The conflicting thing I am going to suggest to you is to give yourself a break. If you are serious about healthcare and invested in becoming an excellent emergency responder than you will. This is a goal that will take time. Your skills will become finely honed over the months. Things you find overwhelming today will be second nature to you quite quickly. The lucky thing is that you may be the first person on scene, but you will almost never be the only person to respond. Trust your team and your own instinct. Your knowledge base will grow over time if you put in the work. For myself, I debrief with my coworkers after a rapid response or a code. I take notes on the debrief and act the response out in my mind, taking into account all of my coworkers’ feedback. If I fumbled with a certain piece of equipment, I spend time with it acting out its function.

The most important tip I can share to help you to succeed during an emergent response is to actively listen and communicate. You will likely have a rush of adrenalin pumping through you during a response and will have to exert extra effort to listen to your team. Do not be silent. If you are unsure of something, asked to do something outside of your preparedness, or see something wrong with the patient; speak up. You are not useful to the patient if you act above your training level or keep your concerns to yourself. Your team will appreciate your transparency. Also, closed loop communication is an essential tool during emergencies. If you are asked to do something, acknowledge the request and repeat back your instructions. This allows the team leader to know that you will be executing the task requested. I have a hearing deficit and miss things over the noise of the group in the room. I try to keep my eyes open and face toward the code leader whenever possible. It can be embarrassing, but I find that I need to boldly call out ‘I couldn’t hear you, please repeat’ often. I remind myself during these occurrences that my pride does not matter more than the patient’s safety.

I hope I have given you insight into some of the key factors that support readiness to perform life saving techniques. What works for me may not be what works for you. What matters is that you take your role seriously and commit to pursuing excellence in your provision of patient care. Fake it until you make it does not apply when it comes to patient safety.