Calling a code on a weekend night shift can feel so lonely; calling a code on a patient that you've known for years can be heartbreaking.  The few minutes it takes for the ICU to respond to an acute care code can feel like an eternity.  So, who do you want responding quickly with excellent assessment skills, holding the team together, and leading the code until a provider arrives...Alfy Almario! 

Alfy responded to a bathroom code light to find a patient unresponsive with weak pulses.  She instantly called for help from her colleagues, started high-quality compressions, and ensured all the code roles were filled.  By the time the ICU team arrived, the team under Alfy's direction had continued compressions, drawn up epi, and given this patient the best possible outcomes.  

Her night shift colleagues continue to thank her for her leadership through a scary situation.  Alfy made sure to call out all members of the team, including the bedside nurse and those who experienced a pediatric code for the first time.  Alfy was able to remain calm under pressure, recognize the great work of her teammates, share her gratitude for the success of her team, and ensure a safe space for people to share their worries.  

Under Alfy's leadership and excellent nursing skills, the patient was quickly transferred to the ICU and cannulated to ECMO, and days later (upon writing this nomination) is recovering with the best possible chance at a good outcome.  Alfy has always been an excellent nurse who holds the team together, but this experience showed how much of a unit leader and example of outstanding all-around care.