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It’s no secret that healthcare workers endure some of the highest stress levels of any profession. This is especially true for Code Blue teams — the highly trained, highly skilled clinicians who respond to the most critical, life-threatening hospital emergencies. 

Of course, there are many strategies that can help manage this hefty mental burden, but they may not be as effective as you think. And with many institutions already struggling to improve cardiac and respiratory arrest survival rates, hospitals cannot afford to ignore the effects of acute stress on their Code Blue teams. 

Keep reading to learn about:

  • Common causes of stress in hospital workers — and resuscitation teams in particular
  • The short- and long-term effects of stress that may impact clinicians as well as their patients
  • How hospitals and staff are currently working to mitigate these effects
  • How innovative solutions, like integrated support systems, can help

Common Causes of Stress in Healthcare Workers

From long hours and high stakes, to growing, industry-wide staffing shortages, the challenges facing doctors, nurses, and other essential frontline workers are truly daunting. 

Every day, they manage multiple patients, all in various conditions from stable to critical, balancing medical training with bedside manner, caregiving, and human connection. Covid adds yet another layer, not only of uncomfortable, alienating, time-consuming PPE, but of fear, danger, and even political backlash that often spills over onto hospital staff.

Resuscitation team members, who typically serve in other roles when they’re not responding to a code, endure all of these stress factors, plus the immediate, life-and-death nature of Code Blues. They must operate at peak performance under immense pressure, making the most critical decisions in a split second, maintaining order within chaos, and staying focused amidst the frenzy. Understandably, this amount of stress can diminish performance — and potentially patient outcomes.

The Impact of Stress on Decision Making

Increased stress levels, especially over long periods of time as is the case with healthcare workers, can have detrimental effects on not only physical and mental health but also job performance. 

According to the American Psychological Association, long-term physical effects of stress include:

  • Hypertension 
  • Heart attack
  • Stroke
  • Inflammation, especially in the circulatory system
  • Anxiety and depression

Healthcare workers and other first responders who are exposed to frequent and fervent stress factors are more susceptible to these risks.1

Perhaps even more alarming for hospitals, clinicians, and patients, stress exposure influences the neural circuitry, specifically in regard to reward processing and learning.2 The result? Long-term and acute stress can cause3:

  • Poor decision making
  • Problem-solving errors
  • Misinterpretation of events
  • Distorted timelines

Any one of these factors could severely impede successful execution of an emergency response, resulting in poor prognosis or even unnecessary loss of life. So, what are hospitals and healthcare workers doing to manage stress today and avoid negative impact on outcomes?

Current Stress Management Strategies

Reducing your Code Blue team’s stress not only keeps them happier and healthier, resulting in higher employee retention rates, but may also boost survival rates and improve prognoses for their patients. Recent approaches to stress management in healthcare workers have been multifaceted to say the least:

  • Some hospitals have implemented holistic or environmental remedies, such as subsidizing mindfulness apps and gym memberships or adding on-premises meditation rooms.
  • Simulation training helps Code Blue responders hone their skills, allows team members to understand and optimize performance in their roles, and — you might assume — increase their tolerance to these high-stress situations. 

But, despite repeated training in simulation settings,  studies have shown that healthcare professionals have similar stress level responses each time they attend to an emergency.4-6 That means the stress response — and resulting impact on decision-making abilities — is likely inevitable.

So what can hospitals do to help resuscitation teams optimize their decision making during cardiac and respiratory arrest emergencies?

Integrated Support Systems: An Innovative Approach

An integrated support system is an advanced digital solution designed to aid in decision making during emergencies. These systems reduce the risk of human error by directing the flow of an emergency response based on best practices and advanced data interpretation. 

In one study, an integrated support system was created for firefighters in charge of leading emergency incident responses. Researchers compared the decision-making abilities of commanders aided by the system against those without it in simulated disaster scenarios. The study found that commanders using the system exhibited significantly improved, more efficient decision making during the event as well as lower overall stress for themselves and their teams.7

How CoDirector® Can Help

Electronic Code Blue documentation on a tablet

CoDirector Resuscitation Software from Nuvara® is an integrated support system designed specifically for Code Blue events. CoDirector provides objective support when response leaders need it most, empowering team members to:

  • Easily guide the flow of care based on Advanced Cardiac Life Support best practices
  • Reduce delays when every second counts
  • Reduce the impact of stress on decision making, especially for team leaders
  • Objectively and proactively collect important data to inform care decisions and interventions during the response and over time


See For Yourself

Ready to learn how CoDirector Resuscitation Software can help reduce stress and improve decision making for your Code Blue response teams?


  1. Gloster AT, Zacharia M, Karekla M. Psychological Aid for Frontline Healthcare Workers. Clin Neuropsychiatry. 2020 Aug; 17(4): 253–254. doi: 10.36131/cnfioritieditore20200406
  2. Porcelli AJ, Delgado MR. Stress and Decision Making: Effects on Valuation, Learning, and Risk-taking. Curr Opin Behav Sci. 2017 Apr;14:33-39. doi: 10.1016/j.cobeha.2016.11.015.
  3. Disaster responder stress management. (n.d.). Retrieved May 12, 2022, from
  4. Hunziker, S., O’Connell, K. J., Ranniger, C., Su, L., Hochstrasser, S., Becker, C., Naef, D., Carter, E., Stockwell, D., Burd, R. S., & Marsch, S. (2018). Effects of designated leadership and team-size on cardiopulmonary resuscitation: The basel-washington simulation (bawasim) trial. Journal of Critical Care, 48, 72–77.
  5. Labrague, L. J., McEnroe-Petitte, D. M., Bowling, A. M., Nwafor, C. E., & Tsaras, K. (2019). High-fidelity simulation and nursing students’ anxiety and self-confidence: A systematic review. Nursing Forum, 54(3), 358–368.
  6. Valentin, B., Grottke, O., Skorning, M., Bergrath, S., Fischermann, H., Rörtgen, D., Mennig, M.-T., Fitzner, C., Müller, M. P., Kirschbaum, C., Rossaint, R., & Beckers, S. K. (2015). Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23(1).
  7. Nagarajan, M., Ganapathy, S., & Cheatham, M. (2022). Model-based decision support system for improving emergency response. International Journal of Human–Computer Interaction, 1–8.
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