Submitted 2024-02-05

Imagine you are watching a patient for a nurse while they are on break. In-between med passes for your two patients, you glance at the additional patient’s monitor at the exact moment her heart rate drops from 66…to 35…to 19…and finally to asystole with an occasional escape beat. In the next five seconds, with a plan in your mind, you manage to initiate emergent care and gather needed help. However, you are stressed because this isn’t your patient and you don’t know much about her. This patient is also post-sternotomy, therefore you cannot code her like you might another patient. You feel there are barriers to you initiating care, and wonder if you have mentally and physically prepared enough for moments like these through what you have practiced, trained for and learned.

To prepare mentally for situations like this it’s important to be able to acknowledge how you normally react in stressful situations. Do you freeze, do you walk away, do you try to fix problems by yourself? Once you figure out how you normally react, you can identify your weaknesses and work on them. Second, it’s important to emotionally separate yourself while still being mentally and physically present. You are no help if you are silent, over-talking, crying, angry, etc. It distracts from the patient if you are needing to be tended to as well. In addition, it is okay to not know what to do, but you need to be able to ask for help, and be able to assist in a role that you do feel comfortable in. One way to be prepared mentally is to begin every shift knowing your patient’s code status, allergies, IV/IO access, what path you would take if they were to code, and any other pertinent information. This allows you to be prematurely prepared in the instance of an emergency, leading to less stress and allowing you to provide quicker care.

When it comes to physical preparation, you need to know what your body can handle. You cannot care for others if you do not take care of yourself as well. Reiterating the statement that you shouldn’t need tending to in a patient emergency, it is helpful to be well rested, fed and hydrated before coming into work. Are you able to give at least two minutes of compressions? Are you able to move quick enough to grab needed supplies and equipment? It is also important to know where equipment physically is around you. Do you know where the code cart/airway cart, extra pads/defibrillator, meds, suction and other important supplies are? Do you know how to use those items or who to hand them to? If you don’t know, ask! Asking, (even when it seems embarrassing), is better than pretending or never completing a task.

An easy way to be better physically prepared is to practice! Learn about and use equipment in non-stressful situations so that you’re more prepared in emergencies. If there is a patient emergency on a patient who isn’t yours, immerse yourself and offer to help. Training through immersion is so important when it comes to recreating a task in an emergency. Hospitals often have free training sessions for a variety of topics, take advantage of it. There are also classes you can sign up for (BLS, ACLS, CALS, IV placement, CRRT, Impella/IABP, etc.) that can help you physically practice necessary skills. Not only is practice and training helpful, but so is educating yourself. Knowing how you prefer to learn will help you better receive information. Whether you research articles, watch videos, or ask other trained personnel, preparing yourself with knowledge gives you a foundation to build off of.

Back to the initial situation with your coding patient, you are prepared because of all your training. When you agreed to watch for that other nurse, you obtained all the necessary information about that patient, which allows you to act quicker, and allows you to share this information with the people who come to help you. You took a CALS class last week and now know what to begin doing to help this post-sternotomy patient. As you quickly pick a role, you delegate to specific people what you need. You are stern, yet calm and collected. You don’t have to be anxious because you have helping hands around you, who all have the same goal - saving this patient. No matter what role you decide you are comfortable taking, every decision you make is governed by the priority of patient safety. Using what you have learned and practiced, and having already been prepared mentally and physically for a situation like this, you have crossed the barriers that prevented you from delivering care, and have taken appropriate action to help save this patient.