What Can A New Grad Do During A Code?

What Can A New Grad Do During A Code?

There is a lot of anxiety amongst new nurses about what will happen during their first code. Will they know what to do? Will they do the right thing? Will they see something confronting? Will the patient be OK? Today we will give you just a little bit of insight into some of the things that generally happen during a code and what your role might be.

*Note there might be numerous ways to talk about a code; MET, code blue, crashing, Rapid Response, Hero Team, MERT etc.

Before The Code

Firstly let's take a step back and talk about what you have hopefully learned before you even get to the point of calling a code...

1. What is the first step when your patient is starting to deteriorate? Your place of work should have a process in place for escalating when a patient is deteriorating and there is usually a "chain of command" so to speak. Double check your hospital policy but usually if your patient is unwell you should be letting your team leader and the medical team know. Whether you start with the junior doctor or the registrar will depend on how unwell your patient is.

2. Do you know what the criteria is for calling a code? What kind of signs should prompt you to call a code? Depending on your workplace there will be certain vital signs or a vital sign score that automatically prompt you to call a code. Other times it might be that the patient is getting worse and you feel you need urgent help that is currently not available on the ward. There are also times where you consider calling a code but then your medical team happens to be on the ward and are able to help. Basically whether you call a code or not, the important thing is the patient gets the help they need when they need it.

3. How do you call a code in your place of work? Where is the button? What is the number?

4. Where is the emergency trolley and what is in it? It's a great idea to go through the emergency trolley a couple of times and familiarise yourself with the equipment. Emergency trolleys should be checked regularly so try and get involved in this.

5. Where is your bedside emergency equipment and what is there? Again familiarise yourself with what you have available and how it works. This should be checked at the start of every shift.

6. What are your patient's goals of care? Hopefully this is included in your handover and/or on your handover sheet. This tells you if you patient wants codes called if necessary, if they want CPR, if they want to be intubated, if they want ICU etc. This is very important to know because you do not want to give CPR to a patient who has explicitly said they do not want it.

Calling The Code

So now your patient is deteriorating, you need extra help fast and you overcome your fears and hit that button. Your colleagues come running to see what is happening... now what?

One of the best things about being a new grad in a hospital is that you are surrounded by colleagues who can support you when your patient is going downhill. What happens next really depends on why the code was called but there are some common things that tend to happen in all codes.

If you are really unlucky your first code might be someone who is unresponsive and requiring CPR in which case take a deep breath and work your way through the DRSABCD algorithm. But most likely your first code won't be that dramatic however it will probably still be freak out worthy and adrenaline inducing.

If your patient is maintaining their own airway and breathing on their own there are a few things that will start to happen in quick succession. Obs will be attended if not already done. Your patient should be returned to bed if possible. If the oxygen saturation is low or the patient appears to be in some kind of respiratory distress oxygen will be applied. If the blood pressure is low it's a good idea to lie your patient down. Someone should have brought in your emergency trolley and a BGL machine. Now is a good time to check your patient's sugars regardless of if they are diabetic. If the patient is having cardiac symptoms it's also a good idea to start hooking up an ECG. Hopefully somewhere during this time your code team arrives.

When they code team arrives they will want a handover. With all that adrenaline pumping you'll probably want to rush right into whatever reason you called the code but hang on a sec... take a deep breath and remember your ISBAR. Briefly and succinctly let your code team know who the patient is, why they are in hospital, any relevant background and then you can tell them why they were called. They might ask you some follow up questions, hopefully you know your patient really well and can answer them but this is not always the case and it is OK to say you don't know but then you should find out whether that be asking the medical team if in attendance or checking your notes, handover sheet computer system etc.

Now is a great time to take a few more deep breaths, your code team is here and they are usually really supportive. They might want things done like bloods, IVC insertion, giving medication and/or hanging fluids. If this is something you are competent with feel free to go ahead but if you are not confident best to speak up and let one of the more senior members take over. Note now is not the time to practice your new IVC insertion skills :-P The other thing that can take some getting used to is starting to prepare medications and fluids before they are documented. If your doctor asks for something make sure you heard exactly what they requested and a second person heard the order and you can get things started whilst waiting for the paperwork. Have faith that your doctor will do the right thing when time allows and also make sure your scribe has charted the order on the scribe sheet.


What's a scribe some of you say? Well that brings me to the next best thing a grad can do in a code and that is... scribe! If you want to see how things work in a code, scribing is a great way to do it. Basically you are responsible for recording everything that happens and everyone who is present. So this will require a bit of confidence to call out to people and ask them what their name and role is. Or you see someone injecting something you gotta say "hey! what are you giving there?" When you are the scribe that is your one and only job so you won't be running off to find equipment or helping to look through notes as you need to make sure you don't miss a thing. It can be a bit overwhelming if things are moving quickly so it might be best to grab someone more experienced to help you the first time but I definitely recommend it for increasing your confidence in managing during a code.

How Does It End?

Eventually the code will come to an end and there are numerous ways it could go. It is possible that your patient may not survive, hopefully this is not the case but if it is you are probably going to be feeling a lot of emotions. The team may choose to take a moment to acknowledge what has happened or maybe they won't. I find personally for my own closure I do like to take a moment to acknowledge the person's life and say my own goodbye. Next, the family will need to be told. Usually the doctor's will do this but if the family is already present they may need support so be prepared with tissues, a shoulder to cry on, offers of tea and coffee and a private place for the family to process.

More often than not though the patient does survive. They may be unwell enough that they need to be transferred to another area. In this case yourself and the code team will escort the patient and you will provide a handover to the new area. Other times they will stay on the ward and if this happens it is important that there is a management plan in place that you and your colleagues feel comfortable with. Often the code team will come back and check on the patient for a while afterwards but also encourage you to call another code if you are worried that things are getting worse again. You should feel confident that you know what you are required to do and you know who to contact if you have concerns.

What Else Needs Attention?

Lastly just a little note for grads who might be on the ward when a code is called but not directly involved... What do you guys do? Well ward nursing is all about team work so it is really awesome when everyone comes together to help. You can check in on the code and see if they need anything and if not you can help to cover the other patients of the nurses who are in the code. There is nothing worse than being in a code and worrying that your other patients might not be OK.


Debriefing is really important for nurses throughout their career but especially for a new grad after their first code. There might be things that happened and you are not sure what happened or why it happened. It is a good idea to have these questions answered for your own peace of mind and also for your professional development. Even if you understood everything that happened it is still a good idea to chat to someone because inevitably it is a big moment in your career and deserves some unpacking. If you don't have anyone you trust to debrief with please reach out to us on our Contact or Facebook page and we are always happy to chat!

I hope that this has helped give you a little more confidence that you will survive your first code and you will be a better nurse for it. If you are still feeling worried have a chat to your ward educator and see if they can help out with running some simulations! Also check out these great links for some more in depth information on recognising and responding to deterioration.

Recognising and Responding to Acute Deterioration Standard | Australian Commission on Safety and Quality in Health Care

National-Consensus-Statement-clinical-deterioration_2017.pdf (safetyandquality.gov.au)

Good luck and be safe x

If you would like to be interviewed or write a guest post for the Nurse Life blog please get in contact at nurselifeaus@gmail.com

Stay safe brothers and sisters!

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