Lesli Fleming

Submitted 2023-08-09

Your eyes flash between the monitor and the patient. You watch as the numbers begin to fall, heart rate 60…40…20. It is time. A moment only for a single calming breath and then you go. Singing your CPR song in your head, the compressions begin and the code blue team bursts through the doors. You can’t help but look down into the patient’s eyes while you continue to pump on their chest. It is okay, it will be okay, you prepared for this.

Basic life support (BLS) and advanced cardiac life support (ACLS) are critical skills for health care providers. Not just to be able to care for a patient, but to also care for yourself. My nursing career began just before COVID in a major city. It was a time of uncertainty and turbulence. As a new nurse, it forced me to develop quickly and face more critical situations sooner than the generation of nurses before me had to. At first, the overhead page of a rapid response or the sound of the code blue button would send anxiety through my body and my mind would race. Who is the patient, where is their family, how bad is it? While these questions are all reasonable given the situation, they may not be helpful for the current life saving actions needed. Being able to fall back on the skills you have learned and the protocols you have practiced makes the actions possible. It becomes almost like a second nature. But preparing and caring for your mind throughout these events is not always as easy.

In order to address mental preparedness, I first had to accept how impacted I was from these emergency medical care situations. It is often hard to accept that these events can have such a significant impact on you, especially when they may be the norm in the specialty you work in or amongst healthcare workers who have been doing this for years. Everyone responds differently and at the end of the day no response is worse or better. I was deeply emotionally impacted by the idea that a family lost a loved one, that the world and their lives would go on without someone they cared for. Once I had realized this I began to try to find ways to combat this. Personally, I spent time learning about and talking with (when possible) my patients. To hear about their lives and their accomplishments. This way I could retrain my perception from a person missing out on future events to someone who has lived a robust life. So when the code blue alarm goes off and the team does everything they can, but life isn’t returned, it can be viewed not as a loss but an end to a story.

Then there is the aftermath. For you, for your coworkers, and for the family. Each a unique experience, but still tied together. Solace in others experiencing similar things and open communication can be saving graces. Healthcare workers share a special understanding especially in these emergency situations and support from peers be it in the form of a silent nod, a hug, or even a dark joke can help to make these situations and the emotions that come after feel less isolating. Talking about it and reviewing it helped me to work through feelings of “I could have done better” or “if I had just noticed earlier”. Without debrief those feelings can follow you home.

Remember the wins, something to hold onto for the hard times. While I will probably always remember vividly some of the worst patient outcomes, finding wins to celebrate brings the light back into the care I give. It can be as small as my patient peed today or they took one step. They can also be big like the team got return of spontaneous circulation or the patient was extubated today. So often the darkness can consume the healthcare profession, but at the end of the day somewhere there is always a win, little or big. Shifting your perspective from focusing on the negative outcomes to also recognizing the positive ones can help to battle this.

My healthcare journey has certainly had its ups and downs with many lives saved and many lost. From the new COVID nurse to the Cardiac Cath Lab Nurse I am today and eventually the Cardiology Nurse Practitioner I will be in the future, one thing has held true, it will be okay. Some outcomes will not be what you wanted, what you fought for, or what you expected, but there will always be wins and patients that make it worth it to continue moving forward. No one ever wants to have to use BLS or ACLS, but having those skills can give you the confidence to walk into the emergency situations and take action.

At the end of it all, as healthcare workers, we are also just people. Self-care may seem just like a buzz word thrown around a little too much, but it makes a difference. I spent a long time trying to figure out what self-care was to me and it was worthwhile. I need to see the sun and be outside, so setting aside the 30 mins after a shift to go for a walk makes a world of difference. That works for me, but won’t work for everyone so investing in yourself to identify your needs is key. But also recognizing that sometimes self-care just is not going to happen and that is okay too.

The healthcare profession, while challenging, offers a unique blend of fulfillment and growth. Embracing the wins while managing the stressors requires a commitment to continuous learning, emotional intelligence, self-care, and collaboration.