The day started when I was floated to a med-surg floor to help with labs, IVs, passing meds, bathing patients, and anything the nurses needed me to do. This was different from my normal habitat in the ICU, but I welcomed the chance to help others and gradually get back into the groove of work after my two months off. I began by introducing myself, trying not to look awkward, cleaning up a massive GI bleed, and smiling so the med-surg nurses didn’t think I was completely incompetent. Of note, I have never been a med-surg nurse, and while I believe I do a decent job in the ICU, the more patients I have, the more scatter-brained I become.
Speaking of scatter-brained – I’m three plus years into my Doctorate of Nursing Practice (DNP) and downgraded to working part-time about a year and a half ago. I really miss my full-time ICU job, but the stress was too much. While I know I am learning other skill sets obtaining my DNP, I have a consistent fear that I am losing my bedside competencies. In fact, every time I work a PRN shift, I worry more about what I have forgotten versus what I have learned. I vowed to myself I would never become an “if-you-can’t-do-you-teach” sort of person. I have always been a “doer,” so my fear of losing my bedside skills has been magnified throughout this degree.
Anyway, back to the GI bleed. I was standing at the nurse’s station taking a breath of fresh air after a highly physical cleanup and a family member suddenly screamed, “I need a nurse!” Now, we all know family members scream. But as an experienced nurse, it is easier to pick-up on that authentic, mortified, desperate, undertone in a voice, indicating they are very serious as this family member was.
A tech made it into the room first and before I could visualize the patient. She saw me coming down the hall and said, “What do we do!?” I moved faster.
When I arrived the patient was agonally breathing. For a split second, my body went into “fight or flight,” then I took a deep breath and compartmentalized my emotions. I felt for a pulse – it was weak and thready. I told the tech to call a code, get the crash cart, and get an ambu bag. I was working in a smaller hospital this day and knew it would take a few minutes before more help could arrive.
About this time, the patient lost a pulse. I started compressions and asked for a backboard. While doing compressions, I noted the time we started coding, and delegated the jobs of medications, recorder, bagger, and someone to switch with me when I became tired. I directed the nurses on how to connect an ambu bag and how to place the defibrillation pads on the patient’s chest. It was like riding a bike and my years of experience reminded me to stay calm. While the nurses and techs didn’t know exactly what to do, they were incredibly receptive and trusted me.
Once the monitor was connected, it was evident the patient was in ventricular fibrillation. I instructed to charge the defibrillator to 150 joules and shock the patient. After the shock, I visualized a rhythm, but still had no pulse. I resumed compressions. Much to my surprise, I felt as confident and comfortable as anyone could given the current situation.
Then, four residents walked through the door. Three of them stood shyly along the wall and one, questioned confidently amidst the controlled chaos, “Who is running this code?”
“Danielle is,” one of the nurses said.
I was actually shocked everyone knew my name, but then all eyes were on me and at this point I was still directing the code and doing compressions simultaneously (not ideal). Then, the resident interrupted my flow by boldly proclaiming, “My name is Jon, and I am running this code now.”
I am all for a doctor running a code and working together. However, this proclamation changed the controlled chaos of the room, to complete confusion. The nurses trusted me up until this point, now they didn’t know who to trust. Jon stood at the end of the bed, while I was still compressing. He suddenly turned red and froze. He tried to speak, but his words were stuck. He wanted to cardiovert the patient with no pulse (this is wrong), but I kindly stopped him. He was paralyzed with fear or maybe exhaustion and now trapped in the middle of at least 20 people waiting for his orders.
As I was compressing, I said, “Jon, my name is Danielle. Look at me.” I pulled a resident off the wall to take over compressions. I told Jon that I found the patient agonally breathing. I then gave Jon a series of events: the patient lost a pulse, I started compressions, started bagging, hooked the patient to the monitor, the patient was in v-fib, the patient was shocked once, was now in PEA and needed an epinephrine. Holding a bristojet of epinephrine I said, “Jon, do you want to give this epinephrine?”
He said, “Yes, I do.”
“Then tell them.” I said.
“Let’s give an epi,” Jon said.
I handed the epi to a nurse by the patient’s IV and suddenly the ICU team arrived. The residents stepped back and the ICU attending took over to intubate the patient. I was happy to see familiar faces who knew me and were confident in my skillset. I forgot about Jon in the code and returned to the ICU to care for the patient.
Later that day, Jon came up to the ICU to talk to me. In a roundabout way, he thanked me for my expertise in the code. I was shocked by his presence. In my career as an ICU nurse, I have never had a doctor go out of his or her way to thank me like Jon did.
It was then I realized that although I haven’t felt it, I have been learning since starting my degree. There was a time, not too long ago, where I would have made someone like Jon feel incompetent. I probably would have snapped at him or “taught him a lesson.” It is almost natural to antagonistically assert yourself over someone when you know more, especially when the other person is perceived to be in a more powerful role. Doctors and nurses do this all of the time. However, I felt no need to do this with Jon. In fact, his “thank you” was enough to prove how fewer words can sometimes have a greater impact.
People always ask me why I chose to go back to school. Some ask because they truly want to know and some ask because they are intimidated or jealous. Some like to criticize the degree path I chose and some want to follow in my footsteps. Going back to school for me was not about the money, nor about the title. Continuing my education to a terminal degree is about personal growth. It’s about learning to navigate through this crazy, twisted, world of healthcare, to better care for patients. Earning my doctorate gives me a goal, a framework, and direction. So while I may not be working full-time at the bedside any longer, my ability to holistically understand people of all types and the confidence and security I have developed through the process, has come full-circle to benefit patient care more than I could ever imagine.
So whether it’s continuing your education, participating in unit projects, or climbing the clinical ladder, every experience matters. While you may feel it isn’t bettering you in the moment, you might be surprised what will happen in the long run. Now, go get em’ team.
NOTE: Names and scenario have been altered to protect the identity of involved parties.