There is always going to be a time when a situation hits that is completely out of your knowledge or comfort zone.
Especially when you are the only nurse in the department on the evening or night shift.
As my first and favorite ACLS instructor said, “In the event of a code, first thing to do is to take your own pulse.”
Because you have to center yourself to be able to help someone else.
It does no one any good if you are panicking.
In an emergency:
Step 1-take your own pulse and center yourself. This will put you in the mindset to deal with a crisis.
Step 2- is there mortal danger? This refers to a patient dying. Or an active shooter. I would consider an active shooter mortal danger.
Step 3- is there immediate danger? This refers to immediate devolvement to step 1. This can also be self immediate danger. An example of this is an unexpected even happened during surgery, such as a sudden finding during a surgery. This unexpected thing can be a hazardous to the patient.
Step 4- Is there ongoing danger? This refers to natural disasters, where the immedate danger has ended (the storm) but there are still ongoing dangers such as downed powerlines, or broken windows.
Step 5- do you know who to contact after Steps 1-3? Knowing who to contact and what forms to fill out will be imperative. Most hospitals have a form that must be filled out with patient information, details about the crisis or break from routine, impact on the patient. There are also forms for employee involvement in a crisis. The last one I personally filled out was when I fell in the OR and smashed my cheek against a trash can in September 2019. Blood exposure may be handled differently by your organization as well. As the only nurse on the shift others may come to you seeking information on how to fill out the internal forms. Always suggest the forms are filled out and turned in. Because if it turns into something bigger, you want documentation on your side. And it is also important to know the person who knows all in the department. There is always 1. And reach out to them, if only to make sure that you have the steps right.
Step 6- is there evidence that needs to be collected and saved to a central location? Depending on the emergency, this may be key. Also, if there is a fire in an OR, and the fire department is called, don’t forget that nothing can be removed from the room after the fire is out and the people are safe and the fire department is gone. This is for the fire investigators.
Step 7- relax, you did a good job. There may be lots of follow up questions. But for now the patient is safe, you are safe.
Until the next time.
Dispatches from the Evening Shift 