A Nurse’s Role in Managing a Code Blue

• A code blue is activated if a patient or individual is found unconscious, without a pulse, or not breathing. Nurses have a huge responsibility of identifying sudden changes in the patient’s status and using critical thinking skills to support the patient as other team members arrive to assist.   
• The management of a code blue involves activating the code as soon as it occurs, sharing clinical information with the team, performing chest compressions, monitoring, and evaluating the code blue process.   
• Situations like these can create panic and uneasiness. Remember that each team member has a unique responsibility, and the team is always there to support each other. 

Editor’s note: This article was originally published Sept. 23, 2022, and updated Aug. 21, 2024.

As a nurse, there typically comes a time when you’ll experience the death of a patient. And as difficult as a code blue can be, it is important to know and understand the proper steps that need to occur quickly during this life-threatening emergency.   

The management of a code blue involves activating the code as soon as it occurs, sharing clinical information with the team, performing chest compressions, monitoring, and evaluating the code blue process. 

The following are important to fully understand when dealing with a code blue:  

• What is a code blue?  
• Who can activate one, and who are the team members? 
• When should a nurse call a code, and what are the responsibilities of the nurse?   
• What does the daily check of the code cart consist of for the nurse?

Defining a Code Blue

A code blue is activated if a patient or individual is found unconscious, without a pulse, or not breathing.  Nurses have the responsibility of identifying sudden changes in a patient’s status and using critical thinking skills to support the patient as other team members arrive to assist.   

In a code blue, the nurse will activate the code, share known clinical information with the team, perform chest compressions, monitor the patient, and evaluate the entire code blue process.

Typically, there’s a code team that depends on the nurse’s critical thinking skills to support and implement the patient’s treatment plan. A code blue is considered an emergency event that requires immediate cardiopulmonary resuscitation.

This type of code is a life-threatening medical condition that requires rapid intervention. If help is not activated immediately, the individual could die. Choking, heart attack, and acute trauma are all conditions that require quick response and immediate treatment. 

Activating a Code Blue and Identifying Team Members

Any healthcare staff who has received training regarding the signs and symptoms of clinical emergencies can activate the code.   

Each healthcare organization should have established policies and standards in place based on the American Heart Association (AHA) guidance that include the following: 

• When to activate 
• Who can activate
• What number to call, or the proper button to push or pull 
• What information to share with the operator  
• Who will respond to the event 
• Who can lead the code
  
• The response time for the team to arrive 
• The role of each team member 
• Management of the code cart – inventory of emergency supplies 
• When to secure or suspend the code 
• Clinical documentation that is required 
• Nursing tasks during the code

The team members of a code blue team involve the following: 

• Physicians – lead the code 
• Anesthesiologist/Certified Nurse Anesthetist – manage the airway 
• Respiratory therapist – supports the airway and administers rescue medicine 
• Pharmacist – manages and prepares emergency medications 
• Critical Care/Code Nurse –supports the team and administers emergency medications 
• Staff nurse – provides clinical data to the team 
• Nursing assistant – performs chest compressions, acts as a runner, and offers relief 
• Nurse supervisor – oversees the process and manages patient transfers 
• Security – ensures that the physical environment is safe 
• Chaplain – provides spiritual support
  

When to Call a Code Blue and Responsibilities of the Nurse

Call a code blue whenever there is a noticeable, life-threatening situation. If someone stops breathing or is actively choking, bleeding profusely, or having a seizure, these are all appropriate times to call a code.   

Nurses can play multiple roles during a code because they often spend more time with the patient.  Many times, the nurse serves as the charge nurse, nurse supervisor, or code blue nurse:

• Charge nurse: Responsible for managing the unit during a code blue and supporting the rest of the nursing staff. The charge nurse coordinates placement of beds and delegates nursing staff to be a runner during the code.   
• Nurse supervisor: Responsible for documenting the time of the event, conditions that led to the event, medical interventions, and patient outcomes. 
• Code blue nurse: Possesses advanced clinical skills and can administer emergency medications such as Atropine, Adenosine, Epinephrine, and others.   

During a code blue event, teamwork is necessary and all members of the team have a valuable role to play.  

Daily Check of the Code Blue Cart

The nurse must check each day to ensure that the code cart has the following essentials in preparation for a code blue event:   

• Code Cart Functionality 
• Airway and emergency supplies 
• Medications 
• Intravenous fluid and tubing 
• Defibrillator and pads 
• Supplemental Oxygen 
• Backboard 
• Needles catheters 
• Suction machine 

The Bottom Line

As with any emergency, having the right medical equipment and healthcare personnel to act in a quick and efficient manner can indicate the difference between a life and death situation. A code blue team consists of individuals who have been specifically trained in how to respond, what to do, what supplies are needed, what actions to take, and the proper documentation to intervene as quickly as possible when a patient is undergoing a code blue emergency.   

Time is of the essence when an emergency arises, and it is necessary that a designated team is knowledgeable and aware of how to act and how to act quickly in order to save one’s life. A code blue event can be frightening for many, but with proper training, supplies, support, and teamwork the tasks can seem less daunting, and an amazing sense of pride and accomplishment is experienced when a life has been saved.   

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