Coping After a Code Blue

Towards the end of my training, we had a day with our trauma coordinator, a nurse who had dealt with many codes in the OR over the years. She was someone who could answer all my questions. She emphasized that everyone would process a code and its outcomes in different ways. Years later, these words still ring true.  

Codes are very stressful and emotional situations for everyone involved. Sometimes, surgery cannot stop while a patient is deteriorating. It can be pure chaos. Regardless of the outcome, sometimes you must keep going with your day. This can be very difficult. So, how do you continue with your day after a code?  

Advocate for Yourself   

You may not be mentally ready to take care of your next patient after a code event. If this is the case, tell the charge nurse or your manager. Many will understand that a short time away from the OR is needed. Take time for your emotions. There can be feelings of fear, grief, anger, guilt, shock, and failure. After the pragmatic work is done—like charting, filling out forms, cleaning up the OR—ask for some time away from the unit so you can process what happened. Finally, remember that it’s okay to cry.  

Debrief With the Team 

Often, the best people to talk to are the ones who understand what you just experienced. Anyone can ask for a team debrief, including you. Don’t be afraid to speak up and ask for one if you deem it beneficial. Sometimes, the physician will initiate this as they are generally seen as the leader of the situation. A manager will likely suggest one if they see team members struggling or recounting the situation. Just like anyone can ask for a count to be done during surgery, anyone can ask for a debrief after a code.  
 
During a debrief, if you feel up for it, it’s helpful to share how you feel because chances are your coworkers are feeling the same way. Try not to focus on “What if…?” or “What else could we have done?” but “What did we do well?” Not everyone may want to participate in the debrief and that’s okay. Appreciate your coworkers who were there to assist. 

Rely on Personal Beliefs and Practices

You can reflect on your personal beliefs to help process what has occurred. Some may have specific religious beliefs while others may have different guiding principles that can help evaluate and comprehend the experience. Maybe you process stressful or emotional events by journaling or meditating. Perhaps, going on a long walk to be alone with your thoughts or sitting in your favorite place at home in silence may be effective for you. Whatever has helped you through a difficult situation in the past can be used for this situation.  

Delay Fully Processing the Event if Necessary 

Sometimes, you will not have time to immediately reflect on what occurred. You may be able to take a short break but then be needed back in the OR. For example, I was the charge nurse one day when we had a code and lost a young woman. The surgeon had more cases and was demanding the team to hurry up and get another room ready when it was obvious they weren’t ready to keep going in the day. I told everyone to take 20 minutes and leave the department. I said it didn’t matter where they went, but they just needed to leave the OR. I went to open and get their next room set up for them. One of the nurses came back after that break and thanked me for my help and for also making them take that break. She still couldn’t process how a procedure that she performed hundreds of times had a bad outcome. The break helped her get some fresh air and regroup so she could take care of the next patient. Remember to take time for yourself after your shift to fully reflect on the events of the day. Don’t just brush them under the rug.