Dealing with nurses/staff at codes

[TateThePharmacist]

---

Members don't see this ad.

Little bit of a newbie here, but I was looking for some input from others who attend codes. How to you deal with the 5 type A personalities all trying to run the code (all of whom are nurses not providers)? How do you deal with nurses asking for meds or drips that the provider didn't ask for? And how do you deal with them when they start arguing with you in the middle of the code when you won't give them what they want? The issue is almost always the nurses. Very rarely do I ever have an issue with the provider.
The only two ways I've seen to handle it is to either be mean and make them cry, or to be a push over and just give them anything they ask for. What's everyone's input?

 

[AC3_PharmD]

Love this question because this is a constant.

1. Establish authority early. I come into every code, announce myself, ask who is leading and determine who I'm communicating with and then position myself in front of the med tray or in some cases if I have space. This prevents nurses from taking things out of my hands, grabbing things out of the tray that aren't necessary, etc.

2. For dealing with the personalities, I've found the best way is to be blunt. If a nurse is screaming and arguing about drips, look them dead in the eye and ask "who is leading the code?" It's not the nurse, they are not licensed to run codes. They aren't in charge, the convo is between you and the provider. It's not making anyone cry or being rude, it is again bluntly but respectfully reminding them that they are not licensed to call out orders, be in charge and that you are NOT going to be taken advantage of by them. If they start arguing about unnecessary things you won't give them repeat the question, point to the provider and state "they didn't ask for it, they're running the code, we're going to go by what the attending says." Sometimes I simply ignore them; if they start yelling they need bicarb drips, NE, etc I look directly to the provider and ask them "what do you want?" This again establishes who is the dominant, authoritative figure in the chain of this emergency - the provider, not the nurse and that is the individual you are communicating with only.

Go to a few and follow that track and those that see you around will get it. Once you start establishing this repertoire they will back off. If they don't maybe it's time to be on some ACLS committees to make yourself a common face so that they understand or talk with the nursing teams about code management.

 

[ValeRx]

Honestly if the nurses cry if you don't do what they ask and are firm with them, they are in no position to be shouting orders and/or making demands.

 

[Sine Cura]

Making them cry seems to be the more satisfying result...

 

[TateThePharmacist]

[/QUOTE]
If they start arguing about unnecessary things you won't give them repeat the question, point to the provider and state "they didn't ask for it, they're running the code, we're going to go by what the attending says."

Once you start establishing this repertoire they will back off. If they don't maybe it's time to be on some ACLS committees to make yourself a common face so that they understand or talk with the nursing teams about code management.
[/QUOTE]

I'm glad to hear it's not just my facility. I really like that response of "why didn't the provider ask for it?" I'm gonna have to use that one. I've been firm with them the whole time I've been at my facility but it's just nurse after nurse that this is happening with. I've talked with some of the more chill staff and it seems like half the ED department is just $#!**# so I may just be fighting an uphill battle here haha. The issue is the providers usually just cave for these nurses and will put in the orders for whatever they asked for so in the end technically there was an order. But they're always unnecessary orders (I've had this happen several times and in the end the patient never needed the drip).
I think I may need to follow the advise of being on committees at this point. I do question if they don't trust me as a resource even though I regularly have the providers asking me questions in front of them. It's really frustrating, but I'm sure everyone experienced that feeling early on in their career.

 

[lane one]

Actually don't have this issue. We do have pretty high nursing turnover though, so outside of the code team they're mostly lost. I'll second what others have said though, it really doesn't matter what the nurses want/ask for, just focus on who's running the code. If you're not sure who's running it when you show up, just watch body language and look the person moving the least. Nurses, respiratory therapists and patient care techs are usually buzzing all over the place while the person running the code is typically observing, directing and thinking. You'll get used to ignoring them in no time.

 

[AC3_PharmD]

If they start arguing about unnecessary things you won't give them repeat the question, point to the provider and state "they didn't ask for it, they're running the code, we're going to go by what the attending says."

Once you start establishing this repertoire they will back off. If they don't maybe it's time to be on some ACLS committees to make yourself a common face so that they understand or talk with the nursing teams about code management.

I'm glad to hear it's not just my facility. I really like that response of "why didn't the provider ask for it?" I'm gonna have to use that one. I've been firm with them the whole time I've been at my facility but it's just nurse after nurse that this is happening with. I've talked with some of the more chill staff and it seems like half the ED department is just $#!**# so I may just be fighting an uphill battle here haha. The issue is the providers usually just cave for these nurses and will put in the orders for whatever they asked for so in the end technically there was an order. But they're always unnecessary orders (I've had this happen several times and in the end the patient never needed the drip).
I think I may need to follow the advise of being on committees at this point. I do question if they don't trust me as a resource even though I regularly have the providers asking me questions in front of them. It's really frustrating, but I'm sure everyone experienced that feeling early on in their career.

Yeah I think it's a constant everywhere honestly. I've found things are worse on the floors and usually the ED is more together so that is surprising. If the provider puts the order in and they don't use it, they don't use it. At least if it's premixed (hopefully) it can go back to the pharmacy or the pyxis/accudose and it's not wasted. The key though I think is consistency and being a familiar face. The more you're there and make yourself a voice the better things will go.

 

[Thephrenicnerve35]

I'm a nurse in the ICU and yes there are some nurses who think they know more than a seasoned pharmacist but if you are confident you know what's going on, always follow the chain of command, ignore them, and alway follow the
physician running the code. Your centerpoint is the one running the code.

 

[RxEvileye]

I have not had this issue, but a tip I learned back on an emergency department rotation is to completely take the medication drawer/tray out of the crash cart and away from everyone in the beginning. Helps reduce the chaos too of them rummaging through everything at the same time.

 

[Rockinacoustic]

I work in the ED, and I frankly don't care who is "maning" the code cart- it doesn't take a pharmacist to assemble bristo-jets. Gives me more time to chart review or retreive meds not in the cart. My role is to ensure we're giving the right drug, at the right time, and anticipate the need for or suggest other treatments. My focus during the code is three people- the provider leading it, the nursing administering meds, and the one recording interventions. All others should be focused on delivered high quality CPR and respirations.

Codes on the floor are inherently a mess- if nurses are asking for inappropriate medications and arguing you need to debrief with them/their manager or report it. Also make sure your department has the same level of competency when attending codes to know when inappropriate things are requested/done.