ACLS Drama

Because of our patient population, unit policy states that to travel with a patient (to radiology, dialysis, or even transferring to the step down unit), the nurse accompanying the patient must be ACLS certified.

Hospital policy states that new-hires must become ACLS certified within 12 months of hire.

Obviously, waiting 12 months to take ACLS isn't really an option on our unit, since a good deal of our patients travel, and not being able to accompany them becomes a logistical staffing nightmare. And that's not even considering the sheer number of codes we see... Therefore, our educator and manager both "strongly encouraged" us to take ACLS before the end of our internship so that we'd be certified when we come off orientation.

My fellow interns and I sit on the front row during the classroom portion of the internship. The classes are combined with all med-surg, tele, and ICU interns, and that's what our unit does--"we're the best of the best, and we act that way." Or so we were "strongly encouraged" to portray by our manager and educator. One day as the internship class broke for lunch, my fellow interns and I discussed heading over to the unit to pick up the books for our Saturday ACLS class so we could take the pretest.

And thus started the ACLS Drama.

The class instructor overheard us, (a conversation she was not part of,) and flipped out.

"You haven't had the entire EKG interpretation internship course yet. We haven't talked about any of the ventricular arrhythmias. We haven't introduced the blocks yet. You won't even understand what they're talking about in the ACLS course, so it's pointless for you to even go right now!"

As insulting as this was ("You're too stupid to take the course!"), I have turned over a new leaf, and I let it roll off my back, shrugged my shoulders, and said, "We're just doing what our manager and educator told us to do."

So the class instructor called our manager to gripe. And she called our educator to gripe. And then she called the ACLS instructor and told her that we'd signed up and couldn't possibly be ready for such an advanced course.

All around us the political (and hormonal I suspect) firestorm raged, but our manager directed us to take the course regardless.

Meanwhile, I had an entire semester of critical care in nursing school that incorporated EKG interpretation throughout. I also had a year's ICU experience where rhythm identification was a daily part of my job. I know what a heart block looks like first degree, third degree, even both types of second degree. I know enough to say, "Oh S#&%!" when the monitor screen fills up with v-fib squigglys or v-tach scribbles. Hell, I even know that a nice pretty rhythm is useless without an accompanying pulse.

But I digress.

When I showed up on Saturday morning for ACLS (with pretest with passing score in hand), we quickly sailed through the BLS portion of the course and then split into renewals and first time certifications. There were only 5 of us first timers--the 3 of us from our unit, and then a nurse with 4 months experience and a nurse with >20 years of experience that had let her certification lapse. As soon as we were separated out, the instructor starts in on a tirade of how those of us in the internship, "with so little experience," weren't going to reap the full benefit of the class, etc, etc, ad nauseam.

I'd had enough.

And so I went all nurseXY on her.

"I guess I'm confused. Do we need to sign up for another class? Are we not allowed to take this class?"

"Well, no, I can't keep you from taking the class."

"Then why are we still discussing this? And when will we move on to the course content?"

Not particularly diplomatic, I know. Rude? Quite possibly.

But SHEESH!!

And so we began. As we moved into the content it was immediately clear she was singling us out with questions, trying to trip us up and make us feel inadequate or unprepared. What she didn't realize was how hard we had been pushed to learn drugs used daily on our unit, most of which are code drugs. She didn't realize the amount of physiologic and pathological knowledge required to get through a single shift on our unit. She didn't realize that we had to truly understand our patients disease processes to even begin managing them.

Everything she threw at us, we had a ready answer for. It was downright inspiring--you could hear the triumphantly rowdy underdog music swelling in the background. And then we caught her in a mistake.

In the end, after all the fuss, in our "but this is the way we do things" face-off, she was the one who blinked first.

As the day moved on into the megacode and we took turns at each position, it was quickly apparent that the other two nurses were actually the weak links.

For example, the one with 4 months of tele experience couldn't wrap her head around the concept of PEA--interestingly enough exactly how much experience our class instructor told us we needed to have to fully understand the intricate subtleties of ACLS. The other, the one with >20 years of experience kept mixing up atropine and amiodarone, and forgetting to defib the patient when appropriate.

One of my fellow interns summed up the day perfectly: "And it was us she was worried about?!?"

Today in class, more than 3 weeks later, we finally went over the heart blocks and ventricular arrhythmias. And wouldn't you know it the whole inappropriately early ACLS class came up again! And then we were politely asked to stop answering questions during the lecture and let others have a chance as we learned about hospital SDMOs on cardiac resuscitation, which oddly enough mirror ACLS.

Ugh. I hate drama.