Planning a Mock Code
Planning a Mock Code
By Ann Marie Frazier, MSN, RN, CNA
At this time of year many of us remember our first position as a nurse. I remember vividly my first job. It was 26 years ago on June 10, 1974, that I was hired to work the evening shift (don't even bother requesting day shift) on a med/surg unit. My orientation consisted of a day of paper work for W-2 forms, health insurance, and how to clock in and out with a tour of the hospital also given. I finally arrived at my job the next day with a crisp white uniform (there were no scrubs) a cap that carried the black stripe of the graduate nurse (GN) and shoes that shone brightly.
My preceptor was the nurse aide (NA) who had been on the unit for 15 years. There was an LPN, the NA and myself for 31 patients. We had no unit secretary, no unidose medications or IV fluids that were pre-mixed. Infusion pumps were unheard of and burretrols were the item of choice for patients on limited IV intake.
There was no unit secretary for the transcription of orders or support services from the ancillary departments. When the patient's meal arrived we had to set up the trays by removing the meal from the "hot side" and arranging all the items for delivery to the patient. In the hospital there were probably a dozen nurses that actually had their RN while the rest of us were GNs running units.
The inevitable happened. There was a code and the only RN present was the supervisor, who was in her 60s. There was no code team and no one from the ED or ICU came to help us. The physician is yelling for medications, asking for cardiac rhythm and laryngoscopes while we stood there nodding our heads up and down and feeling like he was speaking in a foreign tongue! Somehow we managed and people survived their cardiac or respiratory arrest.
To many of us who have been in nursing for awhile (notice I did not say decades) this is a familiar story of how we began in our profession. Thankfully we have expanded our nurturing instincts to include peers and not just individuals lying in their beds or their significant other.
I had the pleasure of having the senior nursing students from Cumberland County College this spring. We were very fortunate that our relationship included their instructor as well as myself. The students found comfort with a staff of employees willing to share unique situations with them and assist them with learning opportunities on the unit.
Several of the students were talking with me one day, sharing their anxiety and fears of their first code. One thing that came to mind was that in the past 24 years not much has changed when it comes to a code situation and students. We still tend to push them to the rear of the room. Our goal is to have them learn through observation, store the information and be able to recall it when they experience their first code as RNs. Our expectation is that they will be able to function appropriately when the need arises by accessing this stored bank of information.
I spoke with their instructor, Martin Manno, MSN, RN, and we agreed to provide them with a learning opportunity that very few students are provided--a mock code. We decided to give them a jump start as they were preparing to become our peers in patient care. Martin consented to use this as an ungraded experience that we would critique for them to learn from. What fun we had!
A mannequin was placed in the bed with the ACLS cardiac stimulator attached. A past medical history, admitting diagnosis and clinical situation were developed to see how they responded. Naturally, the patient needed to code. The students jumped in with both feet. We used this opportunity to have them place the patient on a monitor, interpret the rhythm, start an IV, call the code and bring in the crash cart.
The physician arrived and shot questions and requested interventions faster than they could respond. They fumbled with the medication boxes, could not put the bristojets together and extubated their patient while putting the backboard under it. They could not run a strip, forgot to record the interventions and accidentally shocked their team member when they defibrillated the patient.
When the scenario was completed, the patient room cleaned up and the crash cart restocked they thanked us profusely. We performed a debriefing of the experience to provide the students with the opportunity to discuss what they learned from this experience. The opportunity we provided to them was so successful, another senior class requested the same exercise.
I recently saw one of the students who is now a graduate and awaiting the state board examination. She shared with me how much her class enjoyed the unit, learned from the staff and absolutely loved the code. She told me how they still talked about that experience, which was almost seven weeks before, and that next year's seniors are hoping to be on post intensive care unit. There is nothing better than having someone share with you how you have positively impacted her life.
As we continue our work in caring for acutely ill individuals in a stringent managed care environment, we need to take the time to maximize the learning opportunities on our units. We should be doing this not only for our future peers but also for our staff. Managers need to evaluate the learning needs of their staff members and provide them with the opportunity to expand their knowledge base and achieve their potential. Every one of us has a vested interest and responsibility to help shape the future of our health care providers.
Ann Marie Frazier is nurse manager of the post intensive care unit at South Jersey Hospital, Bridgeton, NJ.