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It’s no secret that resuscitation is one of the most stressful, high-stakes events clinicians experience in the hospital setting. When a patient goes into cardiac or respiratory arrest, time is critical, delays to intervention are costly, and the margin for error is minimal. And with many hospitals struggling to improve outcomes, it’s easy to see how Code Blues can become a source of frustration and dissatisfaction for staff.

But they don’t have to be. Under the right conditions, codes can actually build trust among the response team and increase nurse satisfaction and engagement. For example, a recent study of ICU nurses in China found that responding to Code Blues strengthened their sense of professional calling, even in the midst of the Covid-19 pandemic.1 For many nurses, this finding won’t come as a surprise. Nothing taps into their strong sense of purpose and desire to help patients quite like a life-or-death emergency event.

The catch? Clinicians aren’t likely to experience any positive takeaways from a Code Blue unless the team is operating at peak performance — and knows it. But this can only happen if hospitals provide them with the right tools and support. And at a time when staff retention and morale are trending down, it’s a great opportunity to boost nurse satisfaction.

Keep reading to learn strategies hospitals can use to combat common sources of Code Blue stress and maximize nurse satisfaction.

Sources of Code Blue stress

Although it’s not easy, clinicians are more than capable of performing well and saving patients’ lives under high-stress conditions. So when emergency resuscitation contributes to staff dissatisfaction and burnout, it’s typically not the events themselves, but rather exacerbating factors that are to blame:

  • Difficulty maintaining skills: It’s challenging to keep skills and knowledge sharp when emergency resuscitation events occur infrequently. Although staff receive Advanced Cardiac Life Support (ACLS) training every 2 years, those skills diminish by approximately 70% in 3 months. And by 6 months, 85% of ACLS-certified staff are no longer competent in their skills.2 As a result, it’s easy for clinicians to accidentally stray from the ACLS algorithm in the moment. This escalates stress and forces the response team to make snap decisions about the next steps to take instead.
  • Barriers to effective teamwork: Overcrowding in the room and confusion around team roles are all too common — and can add tension to an already high-pressure event.

Unfortunately, when stress starts to mount, it affects everyone involved. The quality of the code can suffer, leading to poorer patient outcomes. And the tension and frustration can decrease clinician satisfaction and engagement.

So how can hospitals mitigate undue stress during emergency resuscitation? It comes down to prioritizing effective strategies and then utilizing the right tools to execute them.

Strategies to mitigate stress and improve nurse satisfaction

  • Emphasize skill repetition: Put simply, biannual ACLS training isn’t enough. Responders won’t be able to tap into that knowledge during a cardiac arrest unless they’ve built up enough muscle memory, which is what teams rely on to respond consistently across events. This helps to ensure early CPR, timely interventions, and optimal patient outcomes every time.3-4 Plus, when muscle memory kicks in during an emergency, it reduces fear and uncertainty and allows clinicians to focus on the task at hand.
  • Clarify team roles and responsibilities: The response can start to unravel quickly if team members are confused about who is leading the code or feel uncertain about their own responsibilities. But when expectations are clear, team members walk into a traditionally high-stress event knowing exactly what their role is and how they can best support their team members.3

Tools that can help

Code Blue simulations, real-time electronic documentation, and regular debriefing are 3 of the best tools at your disposal.


Bridge the gap between ACLS training and real-life events by providing plenty of opportunities to practice skills in between. Code Blue simulations also give clinicians a chance to clarify team roles before the actual event. In addition, committing to frequent practice sessions can help your hospital comply with The Joint Commission’s revised requirements on resuscitation training and education.

To maximize the benefits of mock Code Blues, focus on the following:

  • Frequency: All hospitals face time constraints, but regular practice sessions pay off. Aim to hold mock sessions monthly to build clinicians’ muscle memory and increase confidence.
  • Realism: Creating a low level of stress during practice sessions allows responders to build muscle memory and better apply their skills in real-life events.4 To do this, try using a more realistic simulation patient or incorporating high-fidelity code blue simulations into the training plan.
  • Team communication: The best time to discuss, practice, and refine expectations around leadership and roles is now — before the team is thrust into a stressful emergency event.


  • Switch from pen-and-paper to electronic documentation to help scribes keep up with the fast, sometimes hectic pace of a cardiac arrest.
  • Help response teams stick to ACLS algorithms by choosing documentation software that offers dynamic, real-time intervention guidance. These features can create awareness and act as guardrails if the team unintentionally deviates from the ACLS algorithm.


Regardless of the outcome, use debriefings after every event as another opportunity to review skills and reinforce team expectations.

  • Review skills and provide clinicians with feedback on their performance. The team already practiced their skills beforehand with mock Code Blues, so use the debriefing as another opportunity to reinforce them. Armed with better knowledge about their skills and performance, clinicians can go into the next cardiac arrest with greater confidence. Or the data might alert them to gaps in their knowledge they need to address going forward. Either way, maximal clinician satisfaction is only possible with regular feedback. And if the team performed well but the patient didn’t survive, clinicians can at least walk away from the event knowing they did everything in their power to help.
  • Encourage reflection and open communication to build trust among the resuscitation response team. How well did the team work together? Was there any confusion around leadership or responsibilities? What can be improved for next time?

The bottom line

Emergency resuscitation is stressful, but response teams are up to the task. When hospitals focus on eliminating unnecessary stress, it improves nurse satisfaction and frees staff up to do what they do best: perform at their peak when a patient’s life is on the line.


CoDirector® Software from Nuvara® can help

Empower your resuscitation response team to perform at their best in a high-stakes emergency event.


  1. Zhu Y, Chen T, Wang J, Wang M, Johnson RE, & Jin Y. (2021). How critical activities within covid-19 intensive care units increase nurses’ daily occupational calling. Journal of Applied Psychology, 106(1), 4–14.
  2. Smith KK, Gilcreast D., & Pierce K. (2008). Evaluation of staff’s retention of acls and bls skills. Resuscitation, 78(1), 59–65.
  3. Prince CR, Hines EJ, Chyou P, & Heegeman DJ. (2014). Finding the key to a better code: Code team restructure to improve performance and outcomes. Clinical Medicine & Research, 12(1-2), 47–57.
  4. Spitzer CR, Evans K, Buehler J, Ali NA, & Besecker BY. (2019). Code blue pit crew model: A novel approach to in-hospital cardiac arrest resuscitation. Resuscitation, 143, 158–164.
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