Team Highlight: Code Neuro Nurses Helping Stroke Patients Every Day

May 29, 2020

Saint Luke’s Code Neuro nurses are a team of highly trained medical professionals whose mission is to be the first response for stroke patients when they arrive at the hospital and save every brain cell possible. Time is of the essence when it comes to treating a stroke. With every second passing, 32,000 brain cells die. A code stroke activation alerts the staff at Saint Luke’s Marion Bloch Neuroscience Institute that a stroke patient is on the way to the hospital and gives them time to prepare. A Code Neuro nurse’s job is to be the first one to respond when the patient arrives and assess what symptoms they’re experiencing and identify where the stroke is located, whether in a large or small vessel in the brain.

Upon arrival, the Code Neuro nurse conducts a National Institute of Health (NIH) stroke scale assessment, which evaluates 11 different components of the patient’s physical state such as level of consciousness, vision, speech, and mobility and rates them on a scale of one to four based on severity. The patient then undergoes a CT scan to determine the type of stroke. It could be an ischemic stroke caused by a blood clot in the brain, or a hemorrhagic stroke caused by a leaking blood vessel in the brain.

Nicole Roberson, BSN, RN, SCRN, has been a Code Neuro nurse at Saint Luke’s since 2011 and says no two days are ever the same.

“Your day is pretty much at the mercy of your pager,” she said. “You can get a stroke activation as soon as you hit the door and they just keep coming, or you may not get an activation until the end of the day and you may get five at the same time. You’re trying to make sure that you’re keeping the physicians, the neurologists, neurosurgeons, the neurointerventional radiologists, as well as the ER physician all in the loop and making sure they are communicating. You’re kind of like a juggler and your goal is to make sure you keep all the balls up in the air.”

Roberson parks on the seventh floor of the parking garage at the hospital so she can see the helicopter pad and know if a patient is already waiting for her when the shift changes. She says it’s critical to get the patient’s "last known well," meaning the most recent time they were without symptoms. Knowing this and examining the CT scan helps them accurately determine if the patient needs a medication called tissue plasminogen activator (tPA), which is a protein that dissolves blood clots. Patients may also go to Interventional Radiology (IR) for a procedure to remove the clot.

The stroke team uses a triage of color codes to group stroke activations based on their potential treatment options and time of onset. A code red means the symptoms started within the past four hours, code yellow means they started within the past four to 24 hours, and anything beyond that is a code green. Roberson says they respond to every code equally fast regardless of code color.

Most of the Code Neuro nurses at Saint Luke’s are recruited from the neuroscience intensive care unit because of their neuro experience and expertise.

“You have to have good time management skills, you have to have great communication skills, and you have to be able to work in the area of gray,” Roberson said. “There are some people who are very black-and-white, you can’t be black-and-white in this world. You’re trying to save as many brain cells as possible by making sure everyone is doing their part.”

Saint Luke’s guide to spotting a stroke is BE FAST.

B – Balance, sudden loss of coordination

E – Eyesight, flashes or sudden loss of vision

F – Face, look for the droop on one side

A – Arms, hold out – does one drift down?

S – Speech, slurring or speaking incoherently

T – Time to call 911

Roberson says it’s extremely important for both children and adults to understand the signs and symptoms of a stroke because once brain cells die, they’re gone. You can’t get a new brain. She tells patients and families that one of the best ways to prevent a stroke is to avoid smoking.

“I love Saint Luke’s. I think Saint Luke’s is great, especially from a nursing perspective because nurses do have a voice here. They respect and understand that we are on the front lines, we have that critical feedback, the experience that everyone can learn from so we can continue to grow and continue to get better. I really appreciate the fact that they are open to our feedback and they want us to participate in things to make those policy changes and those practice changes. Their intention is for Saint Luke’s to be the best place to get care and the best place to give care.”

Saint Luke’s nurses are drivers of change, hope, and innovation. A nursing career at Saint Luke’s means you can learn from Magnet®-designated nurses, grow professionally, and play an integral role in providing innovative and compassionate care to patients. View our open positions today.

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