Staying Calm During a Crisis: Managing Yourself in an Emergency

By Sarah Lorenzini MSN, RN, CCRN, CEN Nov 29, 2023

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You step into your patient’s room and find them pale, diaphoretic and in agonizing chest pain. If that isn’t alarming enough, you witness them suddenly go into ventricular fibrillation.

Staying Calm During a Crisis: Managing Yourself in an Emergency

You step into your patient’s room and find them pale, diaphoretic and in agonizing chest pain. If that isn’t alarming enough, you witness them suddenly go into ventricular fibrillation. Panic sets in. Your hands tremble, your heart races and your mind goes blank. In these critical moments, the ability to maintain composure and take appropriate action is a skill every nurse needs. However, the overwhelming fear that may accompany life-or-death situations can make even the most seasoned professionals freeze up.

By understanding the physiology of stress, implementing targeted mindfulness techniques, and prioritizing their own health and wellness, nurses can tap into their innate capabilities to provide optimal care to their patients.

The Physiology of Stress: Fight, Flight or Freeze

The sympathetic nervous system (SNS) plays a crucial role in the body’s response to stress. When faced with a threatening situation, the body activates the fight, flight or freeze response. The release of epinephrine and norepinephrine triggers various physiological changes that prepare the body for action. The heart beats faster, blood pressure increases, blood flow is redirected to vital organs, glucose is conserved for energy, and mental focus is enhanced. The body becomes stronger, more alert, and capable of faster physical and mental responses. That release of hormones gives you the strength to get a patient up off the ground, the endurance to complete a full two minutes of CPR, and the mental sharpness to notice acute changes in the patient. Those same hormones make your hands shake and your heart feel like it’s beating out of your chest.

This automatic response is designed to optimize your body for action, enhancing physical strength, mental focus and overall performance. Sympathetic nervous system activation is often referred to as “fight, flight or freeze,” as they are the three primary ways we instinctively respond to perceived threats. As a rapid response nurse, I have observed nurses exhibiting the following responses during emergencies:

  • Some nurses adopt a “fight” response, displaying heightened aggression by yelling or snapping at others. This aggressive behavior is their learned coping mechanism in times of stress.
  • Others exhibit a “flight” response, literally fleeing the event once the rapid response team arrives. They may engage in other activities to avoid being present.
  • The most prevalent response I’ve encountered, and one I have personally struggled with, is “freezing.” This state involves an inability to recall patient information, difficulty processing instructions, and a general sense of being overwhelmed.

I understand the surge of hormones in response to an emergency and how paralyzing it can feel. However, I have learned to channel my SNS to help optimize my performance as a nurse. Instead of perceiving the physical manifestations of stress as hindrances, I reframe them as signs that my body is preparing me for peak performance. I embrace the increased heart rate, rapid breathing and heightened senses as indicators that I am ready to act and make a difference. Now when I feel my heart racing and see my hands shaking, I tell myself, “It’s go time!” My body is giving me the extra boost it needs to respond to my patient with even greater strength, speed and accuracy.

How to Manage Yourself in an Emergency

If any of this discussion is true for you, please know there are strategies to overcome your fears. Our mind is amazing. We can retrain our brain to respond differently to stress and learn new neuro pathways, but that takes time and intentionality. Here are some ways to help optimize your ability to respond to a crashing patient:

  • 1 Embrace Self-care: Maintaining your well-being is essential for mastering the SNS response. Practice self-care to mitigate stress and enhance resilience. Engage in activities that promote physical and mental well-being, such as exercise, mindfulness, hobbies and spending time with loved ones. Being tired or hypoglycemic exacerbates negative symptoms associated with the stress response. By nurturing yourself and prioritizing adequate rest, hydration and nutrition, you can maintain composure and sustain your ability to provide compassionate care in demanding situations.

  • 2 Reframe the Stress Response: To harness the power of the SNS, it is important to understand its underlying physiology. Familiarize yourself with the physiological reactions that occur in your body to prepare it for action. By recognizing these physical changes as advantageous adaptations, you can reframe your perception of stress and perform to your full potential during emergencies. “It’s go time!”

  • 3 Education and Preparation: Acquire knowledge and training in emergency protocols and procedures. Continually update your skills, and stay abreast of the latest advancements and evidence-based practices in nursing. The more you understand various emergency scenarios, their signs, symptoms and appropriate interventions, the better equipped you’ll be to respond confidently.

  • 4 Foster Effective Teamwork: In the high-pressure environment of emergencies, teamwork is paramount. Cultivate a collaborative and supportive relationship with your colleagues. Effective communication, mutual respect and clear role delegation contribute to seamless teamwork. During emergencies, rely on the expertise of your team members, and coordinate efforts to deliver comprehensive care. Together, you can leverage the power of the SNS in each team member to provide optimal patient outcomes.

  • 5 Remember to Debrief: Taking time after the emergency to reflect on the positive aspects of the team’s response and areas for improvement is crucial for professional and personal growth. Evaluate your own reactions during tense moments, and acknowledge your successes and areas where you can improve too. Your ability to respond in stressful circumstances is a skill that can be honed with practice.

Becoming proficient in harnessing the power of the SNS is an ongoing journey that requires dedication and continual learning. By embracing physiology and your natural response to stress, prioritizing preparation and education, fostering effective teamwork, embracing self-care and remembering to debrief, you can enhance your ability to excel in patient care emergencies.

Each experience offers an opportunity for growth and refinement. With practice, you will develop the confidence and skills to provide exceptional care when every second counts. Embrace the challenge, stay committed to your professional development, and unlock your potential as an exceptional nurse.

What strategies help you respond confidently during emergencies?