Are NPs code-blue ready?

Traditionally, first positions for graduating registered nurses (RNs) are hospital based. Typically there, everything one needs in order to manage any and all emergency situations is readily available-including interprofessional colleagues who have expertise and experience in emergency management. Quite naturally, this creates a comfort zone. However, when RNs attend graduate school to become primary care nurse practitioners (NPs), planning for managing emergencies in an outpatient medical office may or may not have been a part of graduate education.

For me, personally, this preparation was not a part of my graduate education, and although I gave some thought to what managing an emergency might entail in an office setting in which I was the only NP at the site, until the day I was confronted with one, I did not fully realize the chaos an emergency could create in an outpatient setting.

My on-the-job 9-1-1

In my first medical outpatient emergency, I quickly realized the adolescent I was assessing was in severe distress. I asked the medical receptionist to call in the emergency and urgently request an ambulance. Within a perfect storm of having a new office, a new medical receptionist, and inexperienced staff, who showed up in response to the call and walked into the exam room? Two firemen-each holding an ax! Thankfully, the adolescent was ultimately safely transported to the hospital, but I immediately began to investigate proactive ways to manage emergencies that occur in pediatric office settings.

Cheryl Guttman Krader’s article in the latest issue of Contemporary Pediatrics, “Office preparedness for childhood emergencies,” reviews the American Academy of Pediatrics’ (AAP) recommendations to “make your office code-blue ready.” All NPs need to be familiar with these recommendations and prepare themselves and their office personnel using this best available evidence to manage emergencies that occur in the office. Remember that preparation for emergencies is directly related to quality care: Our children and their families deserve the very best! Make time to review the AAP recommendations and be practice-ready for emergencies!

Calm chaos with your tone

Communicating with the child and parent(s) during an office-based emergency is one specific and essential aspect of the AAP recommendations. Emergency situations create anxiety for all children, as well as the parent and/or caregiver who may have been with the child during initial onset of symptoms. Talking with the pediatric patient in a calm and reassuring voice helps reduce the anxiety. Responding to the emergent health need in a confident manner is also reassuring. Implementing an emergency plan in an organized, methodical manner is essential for a positive outcome. As part of staff training, NPs should prepare office personnel to support the parent during this time of stress. Preparation for this role is based on the educational level of the particular office personnel; however, all individuals can learn basic verbal and nonverbal support techniques to reassure the parent.

Design NP curriculum with emergency prep at its heart

Preparing for office-based emergencies should be an integral part of the NP graduate curriculum. Designing simulation scenarios are an ideal way to prepare NP students for the potential office-based emergency situations. Educating NP students not only to practice for potential emergencies but also to evaluate other student responses during simulation scenarios supports critical thinking and leadership skills that are essential for safe and effective NP practice.

Cool heads must prevail

In retrospect, my first position in a primary care setting-prior to cell phones and Internet access-was a challenge as AAP guidelines were not readily available. However, we managed to critically think through the most likely medical emergencies based on our patient population, and then practiced these and felt prepared for the unexpected. Office personnel were educated using the then-available telephone protocols. Consequently, the day we received the phone call from a frantic mother reporting she was on her way to our office with her child who had “shot himself in the foot,” we immediately instructed her to please bypass our office and go directly to the emergeny department (ED), then we called ahead to the ED.

Proactive emergency scenario training for situations like this will increase office staff confidence to meet the inevitable crisis with the cool heads most likely to ensure safe outcomes.