Code Blue: What to expect and how to contribute as a new RN

by Cathy Parkes

What does Code Blue mean in a hospital?

The Code Blue hospital code is used to indicate that a patient is in immediate need of medical attention—likely because they have gone into cardiac arrest and need to be resuscitated. A team of providers (often called a "code team") must begin immediate resuscitative efforts—including cardiopulmonary resuscitation (CPR) until the crash cart arrives.

What does Coding mean?

The slang term "Coding" comes from Code Blue: you may hear that a patient is "coding" if they have gone into cardiac or respiratory arrest.

In this video, Cathy shares her experience with her first few Code Blue situations as a new nurse and even during nursing school as a hospital transporter. She explains how CPR is actually very hard work and exhausting. She also explains how your role can evolve as more help arrives and how to transition.

As the main actors in a Code Blue arrive like the critical care doctor, ICU nurses and lab, you need to stay there to give a really clear report, especially if you are dealing with your patient.

Cathy also describes what it’s like to lose a patient and how dealing with the family can sometimes be rough when they are emotional and accusatory about the level of care. This can be very rough on new nurses and Cathy explains how she has coped with those situations.


Full Transcript

Hey, I'm Cathy. So I get requests all the time for different types of videos, and one of the requests I got was to make a video about what it's like to go through a Code Blue situation.

So I've been a nurse now for almost three years, and I've probably been involved in say, a half a dozen Code Blue situations. I am less involved now that I'm a wound nurse but as a new grad, and actually before that, I was involved.

So when I was in nursing school I worked as a transporter part-time to kind of have my foot in the door to try to get a new grad position when I graduated. So as a transporter I responded to a Code Blue with my fellow transporter, Gabe, and I decided I was going to try to get in there and do CPR with Gabe and others. So transporters often respond to Code Blues if they are not otherwise occupied and really busy with other transports.

So Gabe and I went into the room and we started alternating with CPR on the patient. Which, when I took my CPR classes, it didn't seem like too big of a deal to do CPR, not super tiring. Well, I'm here to tell you that it is exhausting. It is beyond exhausting.

So I'm in pretty good shape. I work out at the gym a couple times a week. I run. I consider myself in decent shape but I tell you what, doing CPR was exhausting.

The other issue was that I'm short, I'm five foot two, and so I was kind of doing my CPR at an angle slightly and I really just made my neck super sore for like a couple weeks.

I could've gotten on top of the patient, like straddled the patient and done it like that, and that would've been much better form. The issue with getting on top of your patient-- if you're alone, it's your patient or you found the patient and there's no one there yet, then do what you got to do. Get on there and straddle the patient and do that.

But once others respond to the Code Blue and come to try to help, you're kind of in the way if you're on the patient's lap because they're trying to place electrodes and pads and give them IV therapies, etc. So that doesn't work that great. So the other option is you could try to find a stool to get yourself up higher and get a better angle, that wasn't readily available to me during my first Code Blue.

So when we were alternating, typically you would do it for two minutes and have the other person come in and do it for two minutes and alternate every two minutes. But honestly, it was wiping me out, so I would look back at Gabe and Gabe would end up doing it like three minutes, and then I would do it one minute.

So I learned from that that if there are people who want to do the CPR, like these big guys from transport or wherever who are-- some people are super into it and want to get in there and do that, that's awesome. I let them do that because honestly, they're going to be able to provide CPR a whole lot better than I am.

I mean, I was really diligent about making sure I was going fast enough and going deep enough. And again, you're using that Staying Alive, at least that's what I'm singing in my mind to make sure I'm keeping pace. But other people are just more effective at it and do not tire as quickly as me.

So from that one episode, I figured that my role in a Code Blue should probably not be CPR if there are others there that can do it and do it more effectively. So that was my one experience before I became a nurse.

After I became a nurse, in my new-grad period, I was working nights, which-- I can't handle nights. But anyway, I was there for five months, and we had a number of Code Blue situations at night, which gave me some really good experience.

So when you-- I'm going to talk about two different scenarios here, if it's your patient versus if it's someone else's patient. So it's always great to get experience on someone else's patient if possible before you have to kind of manage a Code Blue on your own patient.

So if you're helping out with a Code Blue on another patient that is not your patient, the first thing you want to make sure is that someone is handling your patient. So you just need to ask your resource or mentor RN to kind of keep an eye on your patients or a fellow nurse so that their needs are not neglected while you're helping with this other patient in a Code Blue situation. Once you have that covered, then you can go in and try to help.

So there's a number of ways you can help. If you're super in shape and ready to do some CPR, then sure, go in there and help with the CPR, that will be more than welcome. But if you're like me, and that's maybe not the skills that you can best present to the team, there are other things you can do.

One is you can kind of be on the outside of the room and help fetch supplies as needed. So when they need an IV start kit, they need different supplies, you could run to the supply room, or run to the med room and get those supplies for the team.

The other way that you can contribute, and this is how I like to contribute, is when there is a Code Blue, they'll bring in the crash cart, right? They're going to bring in the crash cart, they're going to put leads on the patient, they're going to put pads on the patient. In that crash cart there should be a notebook, and in that notebook is where you document exactly what time what happened.

When was the patient found, when was CPR initiated, when did we check the pulse, what was the heart rate and blood pressure-- if they got their pulse back obviously, but what was their blood pressure, what time did we infuse-- give them an epi, what time did we give them bicarb if that's something that we're doing.

So when I was involved in Code Blue as a new nurse, I would grab that notebook, and I would kind of be one of the organizers in terms of making sure I have all the data down on the notebook.

So I would write the time, the exact time, and just confirm, "Did you put 1 milligram of epi? Yes. Okay." I put that in there.

Okay, "What's their rhythm? What time did we deliver a shock?" And I put that there.

So basically, you have this running log of exactly what was done at exactly what time, so they can review that. Because there's definitely going to be a whole report and process of reviewing a Code Blue situation. So I just found that that was my comfortable area, where I liked to contribute. I'm good at kind of calling out and organizing things, and so having that notebook was a good way for me to contribute.

If it is your patient though, if you find them and you need to call the code, and you may need to do some CPR and stuff until people respond. But once people respond, and are taking over CPR, it's best, if you're the nurse, the primary nurse, that you are there and can explain to all these people who are going to descend upon your room the patient's situation.

So, the people who will descend upon the room when you have a Code Blue-- usually there'll be a critical care doctor, they'll be ICU nurses, lab will show up, as well as a lot of other resources.

So you need to be there to give a really clear report to the doctors and nurses who are coming to intervene. You need to let them know how old the patient is, what the patient came in for, what their status was this morning, when it started to deteriorate, when the patient was found, what meds they're on, when you gave medications, when you last assessed them, and what was their appearance and concerns, that type of thing.

So, when it's your patient it's best that you're available to do those things, and not be in there doing CPR and not be in there doing the notebook or anything else. You need to be kind of the informant to everybody who is involved.

So I had to do this on-- one of my patients was a full code and ended up a Code Blue. They actually ended up passing.

In most situations, CPR, in the end, is often not effective. Like you may bring them back for a little bit, but ultimately there's a high likelihood that they will pass. Sometimes we are able to bring people back and that's awesome. But it's not the most common case that you're able to save the patient.

So I hope that helps to know what to expect. So when you find a patient you want to call the code. So definitely when you are a new employee there or new nurse you need to figure out what number you dial to get the code. Or if there's a button on the wall you can hit to call a code you need to definitely know that.

So you want to call the code, do the CPR, if there's no pulse until others arrive, and then start coordinating care and communicating to others. And then those ICU nurses and critical care doctors and everybody else will kind of take over for you.

And then you're kind of running interference, potentially with the family. So, in my situation, I had a female patient who coded and her husband-- we called the husband. I actually had my resource mentor nurse call the family because I was giving updates to the door.

So, this is where you definitely rely on your fellow nurses, and your mentor nurse, and your resource nurse to help do things for you. You're kind of delegating.

So she called the family. The family kind of rushed in. It was not a good scene.

He was super upset about his wife's situation and ended up really blaming the doctor and myself for not giving her good care, in his opinion. Which was really not the case. We did a lot.

But that was really, really difficult to hear. And you just need to be prepared for that kind of reaction from family. Because they're grieving and they will in a lot of cases will lash out at you as a nurse and the other staff.

So that was tough as a new grad to hear that. And I did spend a little time in the bathroom crying and a little time outside crying. I had a hard time with it after-- in the moment I was calm getting through it, but when she passed and I had kind of that let down it was tough.

And I really, for my sanity, I had to go home and make kind of a document, list out, kind of my day and what went down to kind of reassure myself that I did everything I could have done. Like when I assessed her, when I gave meds, my concerns when I called the doctor. It was kind of a slow progression downward for this particular patient.

So I kind of documented all of that just for my own sake. And I actually provided a report to the administration at my hospital too regarding the events of the day. That helped me. That just helped me understand that yes, I did everything I could do, and it was not my fault despite the family's reaction to it.

So just be aware of kind of the emotional ramifications of going through a Code Blue, particularly if it's your patient and particularly if a family member lashes out at you.

So anyway, that's my video. I hope it's helpful to give you a feel for the different roles during a Code Blue. What you need to do if it's your patient or not your patient. How a family may respond.

Hopefully, that will give you a little glimpse. But when you're a new nurse you'll experience it and you'll see firsthand. And if you have any other suggestions or comments, feel free to leave those on the video. Thanks so much for watching!


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